A Mesa County sheriff’s deputy who noticed a seizure-prone detainee might not be breathing and let 10 minutes elapse before summoning medical help may be held liable for the man’s death, the federal appeals court based in Denver has ruled.

At the same time, the three-judge panel for the U.S. Court of Appeals for the 10th Circuit agreed that other defendants, including law enforcement and medical personnel working in the Mesa County jail, were not deliberately indifferent to the serious medical needs of Tomas Beauford. The panel reached its conclusion while acknowledging that nurses violated company policies in caring for Beauford, whose physical and mental conditions presented an extreme challenge.

“This is somebody who really shouldn’t have been in this institution (Mesa County jail). I mean, this institution really isn’t able to give someone with Mr. Beauford’s unique vulnerabilities the care he needs,” observed Judge Carolyn B. McHugh during oral arguments in the case last year.

The 10th Circuit’s decision on Wednesday partially reversed a lower court judge who sided with the Mesa County and medical defendants by dismissing the constitutional claims of Beauford’s estate, represented by his mother, Tiffany Marsh. Because the panel concluded the plaintiffs could prove to a jury that Deputy Peter M. Dalrymple violated Beauford’s constitutional rights by delaying medical care the night of his death, the appellate judges also revived the liability claim against Mesa County itself.

David Lane, the civil rights attorney representing the plaintiffs, called it “unfortunate” that the 10th Circuit had declined to reinstate the lawsuit against the other defendants.

“While we are glad to see the court has brought a deputy and the county back into the case, we are disheartened that the court did not agree with us that allowing a jail inmate, who functions at the level of a 5-year-old, to make life and death decisions over his own medical needs does not amount to a civil rights violation,” Lane said.

The lawsuit Lane brought on behalf of Beauford’s mother and estate argued that the medical and law enforcement defendants should have taken additional steps to ensure the wellbeing of Beauford, including forcibly medicating him, ensuring he had access to his seizure-mitigating device, or outright transferring him out of the county jail.

Instead, Beauford — an epileptic who had a severe intellectual disability and several mental health disorders — suffered multiple seizures in the jail and refused to take his medications half of the time.

Beauford came to the Mesa County jail in March 2014 by way of the Grand Junction Regional Center, a mental health facility where Beauford was receiving sex offender treatment. After attacking another resident and three staff members, Beauford arrived at the jail, where he soon had his first of several seizures.

On March 4, jail staff transferred him to solitary housing because of a concern that Beauford posed a threat to others and also due to his vulnerability to exploitation by other inmates. Over the next five to six weeks, Beauford’s medical conditions presented numerous caretaking challenges to the team of nurses working for Correctional Healthcare Companies, a contractor for the Mesa County jail. A recurring problem was Beauford’s refusal to take his anti-seizure medications regularly.

On April 15, 2014, deputies Dalrymple and Richard D. Perkinson were on duty in the jail, along with nurse Renee Workman. The deputies conducted security checks every 30 minutes. At 7:50 p.m., Perkinson observed Beauford grunting underneath his blanket, but believed Beauford was only masturbating and nothing was amiss.

At 8:40 p.m., Perkinson noticed the same behavior, but this time Beauford was shaking. He called for Workman and she realized Beauford was having a seizure. She stayed with him for the duration of the episode, which was approximately five minutes. Perkinson relayed to Dalrymple afterward that Beauford, according to Workman, would be fine.

Dalrymple and Perkinson continued to make their security rounds, at one point returning to Beauford’s cell with Workman to check on him. At 11:55 p.m., Dalrymple noticed during his rounds that Beauford was lying on the floor of his cell facedown, with his head under his desk. The deputy reportedly knew Beauford slept in strange positions. He believed he observed Beauford breathing and moved on.

Shortly after 12:15 a.m., Dalrymple returned to Beauford’s cell and saw Beauford in the same position. This time, he could not tell whether Beauford was breathing. Dalrymple returned to his station and tried to use the intercom to call Beauford in his cell, to no avail. Shortly after 12:25 a.m., Dalrymple called for medical staff, after which Workman arrived at the cell and ordered Dalrymple to begin CPR.

Beauford, at age 24, was pronounced dead hours later. The cause of death was “sudden unexpected death in epilepsy.”

In September 2020, U.S. District Court Judge Daniel D. Domenico concluded that the medical and law enforcement defendants had not violated Beauford’s constitutional rights. The plaintiffs had alleged deliberate indifference, which requires that a person be aware of, but disregard, an objectively serious medical need. While deliberate indifference is part of the Eighth Amendment’s prohibition on cruel and unusual punishment, it also applies through the Fourteenth Amendment to pretrial detainees like Beauford.

“Checking with, and relying on, Nurse Workman — the medical health professional responsible for Mr. Beauford’s care — cannot be considered a conscious decision to disregard an excessive risk to Mr. Beauford’s health,” Domenico wrote. “To the contrary, the Deputies recognized a potential risk, asked the medical health professional what to do about it, and followed her advice. Whether they might have done more doesn’t alter the fact that what they did do is not a constitutional violation.”

While he acknowledged that Workman’s situation was “more complicated,” Domenico also found Workman was not liable because she did not know her actions were likely to result in substantial harm to Beauford. Medical providers, the judge added, “aren’t required to take every possible step to mitigate a risk.”

On appeal, the 10th Circuit panel appeared during oral arguments to agree with many of Domenico’s findings — for example, that defendants did not have a constitutional duty to forcibly medicate Beauford when he refused his medicines.

“I just don’t think it’s there. We don’t have a case,” said McHugh, “where we have held or the Supreme Court has held that it is a violation of the Eighth Amendment not to medicate someone.”

The panel was less willing to accept Domenico’s belief that Dalrymple had not committed a constitutional violation. While Andrew B. Clauss, the attorney for the Mesa County defendants, maintained that the lawsuit was really about negligence and medical malpractice, the appellate judges were unconvinced. 

During Dalrymple’s final checks when Beauford was lying facedown, said Senior Judge Michael R. Murphy, “he failed to act. He went on about his business and he came back and it was too late. That feels like deliberate indifference.”

Clauss responded that Dalrymple had called for medical help on his radio immediately after being unsure whether Beauford was breathing.

“Wait, wait. Does he get on his radio as he is finishing his rounds or after he has completed?” Murphy interjected.

“The testimony that I understand is that when he sees this at 12:15 and he’s not sure, he calls medical,” Clauss answered.

“No,” corrected McHugh. “I have the record in front of me. He completed his rounds and he contacted the nursing staff at 12:25 a.m.”

Clauss maintained that Dalrymple had not realized there was a serious medical need in the moment, unlike if he had “seen blood coming out or something.”

“But isn’t the issue whether Mr. Beauford was breathing?” interrupted Judge Veronica S. Rossman. “It’s subtle, but it’s important.”

Rossman, who authored the panel’s May 25 opinion, concluded that it was improper for Domenico to have dismissed the deliberate indifference claim against Dalrymple. A jury, she wrote, will need to determine whether Dalrymple was aware Beauford may not have been breathing during the 10 minutes before he summoned medical assistance.

“(T)he question is whether Deputy Dalrymple should have been on notice that the Constitution does not permit a ten-minute delay in seeking medical help for an inmate who he knows may not be breathing,” Rossman added. “Here, the contours of the right are clearly established such that any reasonable officer in the situation Deputy Dalrymple confronted at 12:15 a.m. would know that delay could violate the Constitution.”

The panel agreed that Perkinson and Workman had not disregarded Beauford’s wellbeing in a manner that amounted to deliberate indifference. It also rejected the plaintiffs’ other claims related to Beauford’s care leading up to his death. Rossman did, however, note that a failure to ever draw and monitor Beauford’s blood or call the supervising doctor after Beauford’s 8:40 p.m. seizure violated internal policies.

The attorneys representing the defendants did not respond to a request for comment.

The case is Estate of Tomas Beauford et al. v. Mesa County et al.