Date: 11-23-2025

Case Style: Juliana Swink v. Souothern Health Partners, Inc., et al.

Case Number: 16-CV-262

Judge: William L. Osteen, Jr.

Court: United States District Court for the Middle District of South Carolina (Guilford County)

Plaintiff's Attorney:

Defendant's Attorney:

Description: Greensboro, North Carolina personal injury lawyer represents the Plaintiff on medical malpractice, wrongful death and civil rights claims.

David Ray Gsunter was diagnosed with a heart condition shortly after birth. At fifteen years old, to address his heart condition, Gunter underwent open-heart surgery to replace his aortic valve with a mechanical heart valve (“MHV”).
At this time, Gunter was also prescribed Coumadin, an anticoagulant or blood thinner, which reduces the formation of blood clots. Id. Gunter “faithfully and regularly took his Coumadin dosage at a set hour every day” and such regimen “was effective and [Gunter] did not suffer serious complications from his heart condition provided that he faithfully
observed his physicians’ instructions.”

Individuals with MHVs have a higher risk of blood clots than those without MHVs.
J.A. 2147. To ensure such patients are receiving the appropriate amount of Coumadin,
providers monitor the patient’s International Normalized Ratio (“INR”) range, which
indicates, amongst other things, the blood’s thickness and clotting factors. Id. It is
important for individuals with MHVs to maintain levels of anticoagulant within a
therapeutic range and that the levels of anticoagulant do not fall above or below the
therapeutic range. J.A. 245. An appropriate or “therapeutic” INR level for an individual
with an MHV is between 2.5 and 3.5. See J.A. 695, Deposition of Virginia Glover Yoder
(“Yoder Dep.”) 201:14–15; J.A. 1925 ¶ 5. An individual with an MHV that has an INR
level below the “therapeutic” range is at risk for clot formation, while an individual with
an MHV that has an INR level above the “therapeutic” range is at risk for excessive
bleeding. See J.A. 682, Yoder Dep. 78:4–2. Gunter typically took Coumadin once per day
in the evening. J.A. 674, Gunter Dep. 80:9–10. Over the years, Gunter’s daily dosage has
fluctuated between 5mg and 7mg per day due to various factors, including financial access
to medication, diet, and metabolism needs. J.A. 673, Gunter Dep. 74:19; see also J.A. 533.
In early 2012, Gunter was treated by Dr. Virginia Yoder at a Coumadin clinic in North
Carolina. J.A. 1977. Due to financial difficulties, Gunter had trouble securing reliable
transportation to his appointments, and subsequently, was discharged from the clinic on May
31, 2012 for failure to attend. J.A. 695, Yoder Dep. 201:4–7; see also J.A. 1977. Between
May 2012 and November 2012, Gunter asserts he provided lawn care services for a doctor,
who, in exchange for this labor, provided Coumadin and INR testing. See J.A. 1977, 2199.
On November 6, 2012, Gunter was arrested in Forsyth County pursuant to a bench
warrant and was temporarily placed at the Forsyth County local confinement facility. J.A.
245; see also J.A. 672, Gunter Dep. 54:13–20. When Gunter arrived at the Forsyth County
local confinement facility, “he completed a medical intake form, disclosing that he has a heart
condition and alerting that he takes Warfarin1 daily together with other medications and other
medical information.” J.A. 245.

On the morning of November 7, 2012, Gunter was transferred to Davie County
Detention Center (“DCDC”). J.A. 246. Upon his arrival, Gunter was screened by appellee
1 The generic brand of Coumadin is referred to as “Warfarin,” and both brands are
used interchangeably by the parties’ witnesses and district court. See J.A. 1218, Gunter
Dep. 36:12–15. For consistency purposes, this opinion will only refer to Gunter’s
prescribed medication as Coumadin.

Fran Jackson, a nurse and the Davie County Medical Team Administrator for appellee
Southern Health Partners, Inc. (“SHP”), the contracted medical care provider for DCDC. J.A.
94, 246, 566–77, 675, Gunter Dep. 81:7–14. Gunter advised Jackson that he had an MHV and
took Coumadin, which she noted in his medical record. J.A. 94, 532–33. Jackson further
noted that Gunter advised he would have his medications brought to DCDC if he was not
released and advised Jackson to call his doctors if he was not released. J.A. 533. Gunter states
Jackson was not “very nice” and “when she listened to [Gunter’s] heart clicking” stated “[j]ust
because your heart clicks doesn’t mean you have a mechanical heart valve.” J.A. 1228, Gunter
Dep. 88:17–25.

On the morning of November 8, 2012, Jackson contacted Gunter’s primary care
physician and pharmacist about his condition. J.A. 533. According to Jackson’s notes in the
medical records, the clinic where Gunter stated his primary physician worked had last seen
Gunter in June 2012 for a sick visit, but otherwise had not managed his INR levels since 2010.
Id. Jackson’s notes in the medical records further indicated the pharmacist informed Jackson
that Gunter had last filled a prescription for 1mg of Coumadin on October 19, 2012, and did
not have any prescriptions remaining. Id. Jackson also received a faxed medical record from
a clinic, which indicated Gunter reported taking 7mg of Coumadin by mouth daily.
That same day, Jackson consulted with appellee Manuel Maldonado, a licensed
Physician’s Assistant and independent contractor for SHP who oversaw medical care at DCDC
and Stokes County Detention Center (“SCDC”). J.A. 375; J.A. 648, Deposition of Manuel
Maldonado (“Maldonado Dep.”) 30:6–24. Maldonado ordered a prescription for 5mg of
Coumadin and arranged for Gunter to have an INR test completed on November 13, 2012. J.A.
1303–04, Maldonado Dep. 83:20–25, 84:1–5. Additionally, that same day, Gunter’s family
delivered Coumadin to DCDC—two 5mg pills and four 1mg pills. J.A. 540. Nothing in the
record suggests Gunter took or was permitted to take any of the Coumadin pills his family
brought for him. Gunter did not receive any Coumadin on November 7 or November 8 but
received 5mg of Coumadin each day from November 9 through November 14, pursuant to the
prescription ordered by Maldonado. See J.A. 1303, Maldonado Dep. 83:20–25; J.A. 537.
On November 13, 2012, Gunter had an INR test which showed that his levels were
1.07, well below the therapeutic range. J.A. 1304–5, Maldonado Dep. 87:2–5, 96:16–20. As
a result, Maldonado modified Gunter’s prescription to be increased to 7.5mg on November 15,
November 17, and November 19, and remain at 5mg on November 13, November 14,
November 16, and November 18. J.A. 1306, Maldonado Dep. 97:1–14. Jackson administered
Coumadin to Gunter in accordance with the new prescription on November 14 and November
15. See J.A. 606, Deposition of Francessia Robinson Jackson (“Jackson Dep.”) 46:19–25.
On November 15, 2012, Jackson prepared transfer paperwork for Gunter which
summarized Gunter’s condition and listed his treatment/medications. See J.A. 608–10,
Jackson Dep. 55:3–13; see also J.A. 539.

On November 16, 2012, a Friday afternoon, Gunter was transferred from DCDC to
SCDC. J.A. 627, Deposition of Sandra Hunt (“Hunt Dep.”) 27:23–25. SCDC contracts with
SHP for medical services. J.A. 578–92. Gunter arrived at the jail after appellee Sandra Hunt,
a nurse and the Team Administrator for SHP, had left for the weekend. J.A. 628, Hunt Dep.
28:1–2. In accordance with jail policy, a detention officer telephoned Hunt at home to notify
her of Gunter’s arrival and to answer her questions regarding Gunter’s medication. J.A. 628,

Hunt Dep. 28:15–23. Hunt states she was not aware of Maldonado’s order for Coumadin as
the detention officer did not relay that information to her. J.A. 629, Hunt Dep. 29:14–18.
Hunt did not direct the SCDC detention staff to dispense any medication to Gunter, including
the medicine Gunter obtained from his family,2 and absent specific authorization from Hunt,
SCDC detention staff were prohibited from dispensing medication to Gunter. See J.A. 631,
633, Hunt Dep. 33:10–18, 35:4–10. Gunter did not receive any Coumadin on November 16,
November 17, or November 18. See J.A. 635, Hunt Dep. 40:13–17.

On November 19, 2012, the following Monday when Hunt returned to work, Hunt
arranged for Gunter to receive the requisite Coumadin doses on November 19 and November
20. J.A. 1299, Hunt Dep. 69:14–18. Hunt asserts she never received the transfer paperwork
prepared by Jackson. J.A. 629, Hunt Dep. 29:21–23. Nothing in the record suggests Gunter
submitted any grievance forms or pursued any administrative remedies against DCDC or
SCDC related to their failure to provide him with his required dosages of Coumadin.
On November 21, 2012, Gunter was released from SCDC with only the six Coumadin
pills his family initially brought him when he was held at DCDC. Nothing in the record suggests
SCDC prepared a medication plan for Gunter or discharged Gunter with a medication plan.
On November 29, 2012, Gunter was admitted to Wake Forest Baptist Medical Center
(“Wake Forest”) for a blood clot. J.A. 746–47. At the time of his admission, his INR levels
were 1.7, well below the therapeutic range. J.A. 749. His medical records from Wake Forest
indicated that he began experiencing abdominal pain two days before seeking admission and
had been off his Coumadin since earlier that week. J.A. 746–47. Wake Forest surgically
removed the blood clot during Gunter’s stay, and Gunter was later discharged on December
11, 2012, with a therapeutic INR level of 3.16. J.A. 747. Gunter’s INR was subtherapeutic
on four of the five INR tests he received between December 14, 2012, and January 2, 2013.
On January 18, 2013, Gunter was diagnosed with a second blood clot requiring surgeons to
resect part of his bowel.

II.

A.

On December 27, 2016, Gunter filed the operative Second Amended Complaint
(“SAC”) against appellees Davie County, Stokes County, Andy Stokes, Cameron Sloan,
Mike Marshall, Eric Cone, Western Surety Company, and Ohio Casualty Company
(collectively, “Public Appellees”) and Southern Health Partners, Inc. (“SHP”), Jason
Junkins, Sandra Hunt, Fran Jackson, and Manuel Maldonado (collectively, “Medical
Appellees”) alleging that his injuries resulted from the care he received during his
detainment at DCDC and SCDC. See J.A. 222–63. As relevant here, Gunter alleged Public
Appellees and Medical Appellees acted with deliberate indifference toward his
constitutional right to adequate medical care. J.A. 252–53; J.A. 257–58. Gunter further
alleged a Monell claim against Davie and Stokes Counties, as well as a medical malpractice
claim against SHP, Jackson, and Maldonado. J.A. 252–62.

On July 6, 2020, Public Appellees filed a motion for summary judgment, arguing,
amongst other things, they are entitled to (1) qualified immunity, governmental immunity,
and public officer’s immunity, and (2) summary judgment with respect to Gunter’s
Fourteenth Amendment deliberate indifference claim and Gunter’s Monell claim under 42

U.S.C. § 1983. See J.A. 23 (Docket No. 125), 1840–63.

On March 15, 2021, the district court granted Public Appellees’ motion for
summary judgment and dismissed Gunter’s Fourteenth Amendment deliberate indifference
claim and Gunter’s Monell claim under 42 U.S.C. § 1983. Specifically, the district court
opined that “[p]retrial detainees alleging they have been subjected to unconstitutional
conditions of confinement” must allege (1) “the deprivation alleged was ‘objectively,
sufficiently, serious’” and (2) the “prison officials acted with deliberate indifference.” See
J.A. 1842–43 (collecting cases) (citations omitted).

The district court found the evidence did not create a “genuine dispute of material
fact as to whether a violation of [Gunter’s] constitutional rights occurred” for three reasons.
J.A. 1842. First, the district court stated even if the first prong was satisfied, Gunter’s
evidence does not show Public Appellees “were deliberately indifferent to [Gunter’s]
medical needs.” J.A. 1845. Specifically, the district court stated “there is no evidence on
the record that Public [Appellees] intended to prevent or delay [Gunter] from receiving
medical treatment or that Public [Appellees] ignored his medical needs” and the fact Gunter
“disagree[d] with the treatment he received or that a difference course of treatment might
have led to a better medical outcome, . . . is not evidence of a subjective intent by Public
[Appellees] to deprive [Gunter] of medical treatment, which is necessary to state a
constitutional violation.” J.A. 1846.

Second, the district court stated Gunter “ha[d] not presented evidence that Public
Defendants had the medical training necessary to make decisions regarding [Gunter’s] care
. . . and . . . this court does not find that Public Defendants should have understood whether
[Gunter’s] medical care was proper or that it should have been appropriate for Public
Defendants to intervene in [Gunter’s] medical care.” Seeing no constitutional
violations, the district court also disposed of Gunter’s Monell claim. Accordingly, the district court granted Public Defendants'’ motion for summary judgment as to Gunter’s constitutional claims. J.A. 1848–49.

Medical Defendants also filed a motion for summary judgment, which the district court
granted in part and denied in part on March 23, 2021. J.A. 23 (Docket No. 123); J.A. 31
(Docket No. 178). Gunter and Medical Defendants moved for reconsideration. On June 10, 2021, the district court granted Medical Defendants’ motion for reconsideration; granted in part and denied in part Gunter’s motion for
reconsideration; and reopened summary judgment.

On September 17, 2021, the district court struck its previous March 23, 2021
Memorandum Opinion and Order stating that “for purposes of maintaining a relatively clear
record, . . . one opinion and order addressing all summary judgment arguments and related
issues [wa]s appropriate.” That order only addressed claims and motions related to the case
against Medical Defendant

Outcome: Reversed and remanded.

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