Case 1:10-cv-01012-GBL -IDD Document 197-1 Filed 04/07/11 Page 1 of 25

UNITED STATED DISTRICT COURT

EASTERN DISTRICT OF VIRGINIA

Alexandria Division

OBAH FARAH WALKER, )

Administrator of the Estate of )
the late Farah Saleh Farah, )
)
Plaintiff, )
)
v. ) Case #1:10-cv-1012 (GBL/IDD)
)
CORRECT CARE SOLUTIONS, LLC )
)
Defendants. )

SECOND AMENDED COMPLAINT1

Preliminary and Jurisdictional Statement

1. This is an action for wrongful death in a correctional setting, implicating the

constitutional prohibition against the imposition of cruel and unusual punishment. The action

arises under the Eighth Amendment of the United States Constitution and 42 U.S.C. §1983 and

Virginia’s statutes governing death by wrongful act, Code of Va. §8.01-50 et seq. The court has

jurisdiction over the Eighth Amendment claims under 28 U.S.C. §1331 and over the wrongful

death claim against under 28 U.S.C. §1367, the latter claim being so related to the Eighth

1
Beginning at ¶20, the complaint duplicates, verbatim or in abbreviated form, factual
allegations set forth in the Statement of Material Facts comprising part of Ms. Walker’s
previously-filed memorandum in opposition to defendants’ pending motion for partial summary
judgment. There are no factual averments here that do not appear, documented and at greater
length, in Ms. Walker’s Statement of Material Facts. This second amended complaint is identical
to the amended complaint of record for the first nineteen paragraphs and in the statement of the
counts with three exceptions: (1) Merry Brinkley, voluntarily dismissed by Ms. Walker on
compassionate grounds by reason of her serious illness, is referred to as “former defendant”
rather than “defendant,” and grammatical and syntactical changes have been made to conform
the text to this state of affairs; (2) Count IV has been restated to reflect the allegations set forth
here, and (3) Count I contains an express rather than implied request for punitive damages.
 Case 1:10-cv-01012-GBL -IDD Document 197-1 Filed 04/07/11 Page 2 of 25

Amendment claims over which this court has original jurisdiction that it forms part of the same

case or controversy.

Parties

2. Plaintiff Obah Walker is the sister and the duly appointed administrator of the estate

of

the late Farah Saleh Farah, a mentally ill man 24 years of age, who died on January 23, 2008 of

dehydration after having been in the Alexandria jail for 13 days under defendants’ care.

3. Defendant Correct Care Solutions, LLC (“CCS”) is a Kansas corporation whose

principal place of business is in Tennessee. It is a for-profit company in the business of

contracting to provide health care to prisoners in certain American jails and prisons. At all

relevant times it was under contract to provide such services to the inmates of the Alexandria

Adult Detention Center (hereafter referred to as “the jail.”) CCS provided its services here at

issue through the work of its employees and agents, including the named and unnamed

employees and agents referred to in this complaint. In regard to the matters here at issue CCS

acted at all times under color of state and local law, in discharge of governmental obligations to

provide necessary medical care to inmates incarcerated in the jail.

4. Defendants Nigist Ketema and JoAnn Smith were, at all relevant times, employees of

CCS working full time as nurses at the jail. On information and belief defendant Ketema was a

licensed practical nurse and defendant JoAnn Smith was a registered nurse. Their actions and

omissions here at issue were taken within the scope of their employment with CSS.

-2-
 Case 1:10-cv-01012-GBL -IDD Document 197-1 Filed 04/07/11 Page 3 of 25

5. Former defendant Merry Brinkley was, at all relevant times, an employee of CCS

working full time as the CCS medical administrator at the jail. On information and belief she

was a registered nurse. She was responsible for ensuring CCS staff performance in accordance

with the standards required by law, by CCS’s policies published to the sheriff and to the City of

Alexandria, and by CCS’s contract to provide medical services to jail inmates. She was on call

24 hours/day, 7 days/week to coordinate any health care issues. Her actions and omissions here

at issue were taken within the scope of her employment with CSS.

6. The defendants herein were all acting under color of state and local law in connection

with their actions here at issue, by reason of their undertaking to fulfill constitutional obligations

of the Alexandria sheriff in relation to ensuring the health and well-being of inmates committed

to the jail. Each defendant is a “person” within the meaning of 42 U.S.C. §1983.

Claim for Relief

Background Events

7. Plaintiff’s decedent Farah Saleh Farah was born in New York City in 1983. In 1991

he moved with his family to Alexandria, where he attended T.C. Williams High School. Until

approximately his eighteenth year Farah suffered from no significant mental health problems.

Starting in or around 2003, he began to display disturbing symptoms. In 2004 he was diagnosed

as suffering from paranoid schizophrenia. His condition was treated with medication.

8. When Farah stayed on his medication, he was functional, social, competent, and

friendly. When, as a result of his mental illness, he did not take his medication, he would,

among other things, starve himself and refuse water, becoming dehydrated to the point that on

-3-
 Case 1:10-cv-01012-GBL -IDD Document 197-1 Filed 04/07/11 Page 4 of 25

several occasions when he was brought by family members to the hospital for emergency

intervention he had to be hydrated via an intravenous (“I.V.”) line.

9. In approximately the spring of 2007, Farah, on information and belief off his

medication at the time, obtained a handgun. Shortly thereafter he was arrested for carrying a

concealed weapon. He was living at home at the time, with his parents and two sisters.

10. In November, 2007, Farah pleaded guilty to the charge of carrying a concealed

weapon. He was sentenced to serve three months in the Alexandria jail and nine months on

probation, conditioned (among other things) on his remaining on his medication as prescribed.

Farah’s November 2007 - January 2008 Incarceration

11. Farah reported to the jail on or about November 28, 2007. He stayed there until

being discharged directly to Mt. Vernon Hospital on January 4, 2008.

12. During the period of Farah’s November -January incarceration, Farah stopped taking

his medication, Seroquel, an anti-psychotic. His mental condition notably worsened. He also

refused to see his family members, who, pursuant to jail protocol, could not see him without his

permission. He also stopped eating normally and lost weight. All these adverse behaviors

resulted from his mental illness.

13. In December 2007, plaintiff Obah Walker spoke twice with unidentified personnel at

the jail by phone in an effort to provide and also to receive information about her brother’s

condition. On both occasions she described his periodic self-deprivation of food and water when

not on his medication. She asked for assurances that he was being properly cared for. On both

occasions, the person with whom she spoke declined to provide any information. One of the two

refused to identify herself.

-4-
 Case 1:10-cv-01012-GBL -IDD Document 197-1 Filed 04/07/11 Page 5 of 25

14. During the period of Farah’s incarceration in November 2007 - January 4, 2008,

defendants were responsible for providing health care to jail inmates, including Farah. On

information and belief, all individual defendants were aware, via personal dealings with Farah or

from medical records that they were charged to maintain, of his illness, his failure to take his

medication, his failure to eat, and his significant mental and physical deterioration.

15. In the period prior to his discharge date of January 4, 2008, Farah began to exhibit

symptoms and behaviors sufficiently problematical that mental health staff at the jail deemed his

hospitalization appropriate. He was not brought to the Northern Virginia Mental Health

Institute, where he had previously been seen, because that facility required preliminary

laboratory studies which CCS would not provide. Arrangements were therefore made for

Farah’s transfer to Mt. Vernon Hospital, and a temporary detention order (“TDO”) mandating

his hospitalization there was secured. On or about January 4, 2008, Farah was discharged from

the jail directly to Mt. Vernon Hospital.

Farah’s Hospitalization and His Brief Re-Incarceration

16. On January 7, 2008, Farah attended a civil commitment hearing for the purpose of

determining whether he would remain involuntarily detained at Mt. Vernon Hospital. While he

had at times refused to eat, he had been compliant with his medication while in the hospital, was

apparently oriented to his surroundings, and denied suicidal and homicidal ideation. The

presiding magistrate found that under the applicable legal standards, Farah could not be detained

involuntarily as a danger to himself or others, and ordered his release.

-5-
 Case 1:10-cv-01012-GBL -IDD Document 197-1 Filed 04/07/11 Page 6 of 25

17. Following his release, Farah reported to his probation officer, as required. He told

his probation officer that he refused to take his medications, which he also said he did not need.

These statements were themselves manifestations of his mental illness. The probation officer

reminded him that taking his medications was a condition of his continued probation, and

directed him to return to the probation office on January 10 with his medications in hand.

18. On January 10, 2008, Farah reported back to the probation officer as directed. He

did not, however, have his medication with him, and said that he refused to take it, thereby

manifesting his mental illness. The probation officer thereupon requested issuance of an arrest

warrant for Farah for violating the terms of his probation.

19. Later in the day on January 10, 2007, Farah was arrested for violating the terms of

his probation and brought back to the jail. He remained there until the day of his death 13 days

later.

CCS’s Posture Towards Farah As A CSB Client

20. At all relevant times, Farah was receiving mental health services from the Alexandria

Community Services Board (“CSB”), whose client he was. He saw CSB psychiatrists and social

workers both when in the jail and when living freely.

21. The CCS staff knew of Farah as a mental health client of the CSB’s from his prior

history and from his identification as such on the jail’s booking unit bulletin board. At least some

of the CCS staff (not, however, including any defendants) also read Farah’s mental health

progress notes.

22. CCS and its employee defendants take the position that Farah, who as a CSB client,

was concededly under the care of a CSB psychiatrist, was not their patient at any relevant time.

-6-
 Case 1:10-cv-01012-GBL -IDD Document 197-1 Filed 04/07/11 Page 7 of 25

“The defendants deny that Farah Saleh Farah was under their care or the care of any of their

agents and/or employees....” (Defendants’ Answer to Complaint, ¶2; Defendants’ Answer to

Amended Complaint, ¶2). As stated by CCS’s Chief of Institutional Operations, “[I]f [Farah had

a chronic care plan], it would be a psychiatric (sic) that would not be our responsibility.”

23. CCS denies (sic) that it was the responsibility of HSA Brinkley to be sufficiently

familiar with the jail medical and mental health records of the inmate patients seen at the jail so as

to be able to facilitate continuity of care for any ongoing medical or related conditions.

24. CCS denies (sic) that defendants Ketema and Smith, and HSA Brinkley, were

required to be familiar with Farah’s medical and mental health history at the jail so as to be able

to provide him with appropriate care.

CCS’s Training Failures

25. The provision of health care in a correctional setting requires substantial specialized

training of otherwise educated health care professionals. CCS’s touted expertise in correctional

health care is what secured its contract from the city.

26. By its own admission, CCS provided no training on any of the following matters to its

nurses: the taking and recording of vital signs – why, and how often; distributing medication to

patients; getting reluctant patients to take medication; forcible administration of psychotropic

medications; identifying signs of dehydration; dealing with patients appearing to suffer from

dehydration; making notes on patient interactions or developments; when and why to call for

assistance from more fully credentialed health care personnel; when and why to recommend

emergency treatment or transfer to an emergency room; and the function of and testing for

electrolytes.

-7-
 Case 1:10-cv-01012-GBL -IDD Document 197-1 Filed 04/07/11 Page 8 of 25

27. All new employees were supposed to be oriented and trained relative to their duties

and responsibilities in the jail, including the policies and procedures set forth in the CCS nursing

Policies and Procedures Manual, and documentation of that orientation and training was to appear

in each employee’s personnel file.

28. None of the numerous LPNs who dealt with Farah, including defendant Ketema, has

an Operations Site Orientation Checklist or similar document documentation in his or her file.

Nor does defendant Smith, an RN, have any such document in her file.

29. Illemboyo Awosika, an LPN who was tasked to give Farah his medication, recalls

having received a copy of the CCS personnel manual but no other orientation documentation or

training. Another of Farah’s medication nurses, Shelby Crandall, could not recall, at her 2011

deposition, having looked at a CCS policy book since CCS took over the jail contract six years

earlier. She denied that CCS had any policy for addressing dehydration, and was not sure if one

existed for dealing with nausea or vomiting. Ms. Crandall received no training whatsoever from

CCS regarding medication documentation or other portions of a patient chart.

CCS’s Failure to Report Farah’s Failure to Take His Medication

30. On January 11, 2008, Farah received his initial medical and mental health screen at

the hands of CCS nurses. The physical assessment screening was not done. The mental health

screening and assessment form was not completed, notwithstanding that the nurse noted Farah’s

history of mental health medication and hospitalizations. His schizophrenia was not noted. The

screening nurse could not account for this incompleteness. Screening forms were to be reviewed

and counter-signed by a charge nurse. This too was not done. The screening nurse could not

explain what the review protocol, if any, was. The DON could not explain how this incomplete

-8-
 Case 1:10-cv-01012-GBL -IDD Document 197-1 Filed 04/07/11 Page 9 of 25

record had been generated, or if it had ever been discussed with anyone.

31. On January 14, 2008, Farah was seen by Albert Yoon, M.D., the CSB psychiatrist

who had been following him before his final incarceration. Dr. Yoon noted: “Came back 5 days

ago after violation of probation. Mental status: no change,” and prescribed continuation of the

Seroquel Farah had been receiving. Dr. Yoon’s note formed part of Farah’s CCS medical chart

and was available for review by CCS nurses and HSA Brinkley.

32. CCS followed a protocol, mandated by the National Commission on Correctional

Health Care (“NCCHC”), requiring that a patient missing three consecutive doses of medication

be referred to the prescribing authority.

33. Distribution of medication was done and documented by CCS nurses. Before

administering medication, nurses were to sign their names and place their initials at the bottom of

the MAR, so as to permit their identification. They would give medication to their patients and

place their initials in the square for the proper day and time. When a patient did not receive the

prescribed medication, the nurse was to circle his or her initials in the appropriate square, and on

the following page of the MAR explain the reason for the non-receipt. A refusal form was to be

filled out, signed and witnessed.

34. Nurse Awosika was unacquainted with the protocol set forth in ¶33, notwithstanding

that he had worked in the jail since before CCS got the contract. Nurse Shelby Crandall

professed knowledge of it but had not acted accordingly on Farah’s MAR.

35. Farah’s MAR shows that he was to receive Seroquel, a psychotropic medication,

every morning and evening starting January 14, for sixty days. He received no medication on the

14th, nor any at 9 p.m. on January 15, there apparently being none “available.” Farah was not

-9-
 Case 1:10-cv-01012-GBL -IDD Document 197-1 Filed 04/07/11 Page 10 of 25

offered his medication on the morning of January 22 (the day before he died). This is not

explained. Farah never took his morning medication except possibly on the morning of January

18. He never took his afternoon medication except possibly on the afternoon of January 21.

36. Out of the twelve occasions when Farah was recorded on the MAR as not taking his

medication in the period Jan 15-22, explanations were provided, as required, only eight times.

Out of the fourteen times that Farah had not received his Seroquel during earlier incarcerations (in

2007), explanations were provided by CCS nurses for only six. DON Lewis could not explain

this, notwithstanding that it was part of her job to ensure proper documentation.

37. Nurses Awosika, Crandall, McCarthy and Kim were involved in the attempted

distribution of medication to Farah dating back to a year before his death, as well as being

employed during Farah’s final incarceration. None of their CCS files contains any

memorialization of counseling, reprimand, or discipline for failure to have maintained Farah’s

MAR properly. Similarly, there is no documentation in Ms. Mason’s or Ms. Lewis’s file

regarding their failures to catch these defaults, even after Farah’s death brought these matters into

sharp relief.

38. Apart from making notes on Farah’s MAR, none of the medication nurses otherwise

reported the fact that this patient was not taking his medication. There is no notation in Farah’s

medical chart of any sort stating or implying that any nurse ever undertook to report the non-

receipt by Farah of his medication to anyone: not to an RN, the DON, the HSA, the CCS

physician, or anyone with the CSB, including the prescribing psychiatrist.

39. CCS’s policy, J-I-95, required that after a patient refused medication three times, this

was to be reported to the prescribing physician. It was a complete dead letter. For her part,

-10-
 Case 1:10-cv-01012-GBL -IDD Document 197-1 Filed 04/07/11 Page 11 of 25

Sylvia McCarthy, the last nurse to have offered Farah his medication (on the day before he died)

followed a personal protocol of permitting patients to go for one week (sic) before reporting non-

compliance. Discovery has revealed no documentary or testimonial evidence to the effect that

any CCS nurse reported Farah’s failure to take his medication except on the MAR itself.

40. The files of none of the nurses who experienced Farah’s refusal to take his Seroquel

in January 2008 – nurses Awosika, Crandall, McCarthy, and Kim – reveal no memorialization of

counseling, reprimand, or discipline for failure to have informed either the prescribing

psychiatrist or an RN, the Director of Nursing, the HSA, the CCS physician, or anyone from the

CSB that Farah was not taking his medication. Throughout, it was the responsibility of HSA

Brinkley to see that inmates’ medical records were properly maintained. Over two years after

Farah’s death, CCS’s Chief of Institutional Operations professed ignorance of whether she had

discharged that role properly. Id. Angeniece Mason, a CCS registered nurse, was also supposed

to check Farah’s MAR for completeness. She does not recall having done so, however and

presumably did not, since she also testified that faced with evidence that a patient was not taking

prescribed medication, she would have referred the matter to a doctor.

41. The CSB personnel providing mental health care to Farah were aware of Dr. Yoon’s

January 14, 2008 prescription of Seroquel. Having received no information to the contrary from

CCS nurses, they reasonably assumed that Farah was taking his medication. The CSB record of

Farah’s final incarceration includes the following references to his medication (all from January

2008): Jan. 11: Farah “does not see why he was ‘being forced’ to take medication”; Jan. 14: Farah

“understood medication benefits versus side effects; Jan. 14: Seroquel prescribed, Farah having

rejected Clorazil; Jan. 15: Farah “taking meds, per note”; Jan. 17: Farah to meet with staff

-11-
 Case 1:10-cv-01012-GBL -IDD Document 197-1 Filed 04/07/11 Page 12 of 25

psychiatrist “as needed for medication management”; Jan. 22: Farah “saw the psychiatrist last

week and he should be getting his meds”. No one from the CSB was ever informed by CCS that

Farah was not taking his Seroquel. Exactly the opposite was the case, as expressly attested to by

the CSB social workers and therapists who worked with Farah. Guards who rotated on duty at the

booking unit may have had sporadic or anecdotal evidence of Farah’s declining his medication,

but their information was neither systematically obtained or systematically recorded, and on

medication matters, they acted only on instructions of nurses.

42. On January 17, 2008, Farah’s case came up at the jail’s weekly Inmate Management

Team (“IMT”) meeting of various units of the Sheriff’s Department, CCS and the CSB. Farah

was on the IMT agenda with the explanation “awaiting space mental health,” and his case was

discussed. HSA Brinkley was present for this IMT meeting. HSA Brinkley and CCS did not

view it as her responsibility, however, to be sufficiently familiar with the jail medical and mental

health records of inmate patients so as to be able to facilitate continuity of care for any medical or

related condition. HSA Brinkley was not aware of Dr. Yoon’s January 14, 2008 Seroquel

prescription or any other medication information available in his chart, since she did not read it.

She was not in any position to inform anyone of Farah’s failure to take his medicine.

43. On January 18, 2008, Yorvska Salazar, a psychologist working for the CSB, was

called to see Farah. She asked him if he was taking his medication. He said he was not. Because

Farah “presented with psychosis,” Dr. Salazar did not accept what he said at face value and went

to the nurse’s station to inquire. The nurses did not, however, provide her with any information.

They did not pull Farah’s MAR to check. They sent her, rather, to speak to HSA Brinkley or

DON Lewis. Such reluctant cooperation with CSB personnel was apparently common among

-12-
 Case 1:10-cv-01012-GBL -IDD Document 197-1 Filed 04/07/11 Page 13 of 25

CCS staffers. By contrast, CSB mental health data was always available to CCS staff when

requested.

44. Dr. Salazar does not recall what she was told by the CCS administrator to whom she

spoke. The person to whom she spoke retrieved or consulted no records when responding to her

inquiry about Farah, as she recollects. What she does recall, however, is that as a result of what

she was told, she did not fill out a “Mental Health Action Form.” This form was used by CSB to

inform both deputies and CCS personnel of any changes needed in the care or supervision of an

inmate for newly learned mental health reasons. Dr. Salazar herself had filled out just such a

form for Farah after seeing him on January 11, 2008. On January 18, however, she did not. “If

there’s no change, we don’t put in a different Mental Health Action form.” Based on whatever

she was told on January 18 by HSA Brinkley or DON Lewis, she saw no need for any change or

adjustment in his treatment.

45. This was not be the first time for such an occurrence. The provision of incorrect

information by CCS staff regarding the medication of inmates was a problem for the CSB staff

throughout Farah’s 2007 and 2008 incarcerations.

The Events of January 21, 2008

46. Shortly after 2 a.m. on January 21, 2008, Farah started shouting out that he wanted

ginger ale, a doctor, an “an I.V.” Hearing this, a deputy went to get the nurse on duty. This was

defendant Ketema, the sole nurse on duty.

47. Defendant Ketema came to Farah’s cell. Farah told her that he “needed ginger ale

and IV.” He was “vomiting.” Defendant Ketema saw no food, only liquid, in the vomitus. Farah

“could not stand up” or clean his cell. Defendant Ketema told Farah “You can’t do it because you

-13-
 Case 1:10-cv-01012-GBL -IDD Document 197-1 Filed 04/07/11 Page 14 of 25

don’t have that energy.” His skin was “kind of dry,” with “a kind of dry whiteness.” His eyes

were “you know, his eyes also fitting inside, and his face was, it’s a kind of – I don’t know how to

explain – it was kind of sluggish, and he was weak.” She found Farah “confused.”

48. Defendant Ketema is the last person known to have seen Farah standing. When he

was seen later that morning by defendant Smith, he was lying on the cement floor of his cell. The

following day he was seen lying (possibly sitting) on his cot.

49. On January 21 when Farah was seen by defendant Ketema, he would have been

severely ill and obviously in need of immediate medical care. A person encountered in this

condition outside of the jail would most likely be taken to the emergency room. This should have

been obvious especially to medical and nursing personnel.

50. Defendant Ketema identified virtually all the signs of severe dehydration. She also

expressly came to the “nursing judgment” that “I thought it was dehydration.” “I say maybe it’s

dehydration; ... they told me he didn’t eat the ... last two days or three days.” Id. at 13073. While

nurses cannot “diagnose,” they can make nursing judgments, and that is what defendant Ketema

made here.

51. Defendant Ketema’s specific observations regarding Farah’s vomiting, nausea,

dryness, eyes, and skin and her contemporaneous nursing judgment of dehydration were accurate.

They are consistent with the results of the autopsy immediately following Farah’s death two days

later, attributing Farah’s death to dehydration and finding “sunken eyes, dry tissue, skin tenting

and electrolyte abnormalities.” Defendant Ketema’s observations are also consistent with the

assessment of Jonathan Arden, M.D., Ms. Walker’s forensic pathologist, made on the basis of the

analysis of the medical examiner.

-14-
 Case 1:10-cv-01012-GBL -IDD Document 197-1 Filed 04/07/11 Page 15 of 25

52. Defendant Ketema knew that it was necessary to call for a doctor when faced with a

patient who presented the signs of dehydration she saw in Farah.

53. DON Lewis and the CCS physician were on call 24 hours/day, 7 days/week, and

defendant Ketema knew how to call for a doctor if needed. Defendant Ketema called no one.

Nor did she attempt to cause Farah to be sent to the local hospital emergency room.

54. Defendants Ketema and Smith deny that they had access to Farah’s medical record

except for the MAR (and in defendant Smith’s case, Dr. Yoon’s January 14, 2008 note noting

Farah’s unchanged mental status and recommencing his Seroquel). Defendant Ketema did not

write a progress note on January 21, 2008 memorializing the symptoms she discerned and her

conclusion of dehydration because, she says, she was unable to find Farah’s chart.

55. Defendant Ketema reported on her dealings with Farah to her replacement on the

morning shift, defendant Smith, who came in almost five hours later. It was her “habit and

practice to provide a complete report on inmates whom she saw in a professional capacity.” She

recalls communicating that Farah had not eaten, that he had asked for ginger ale and an I.V., and

that he was nauseous and vomiting. She was told by defendant Smith that the doctor would not

be in that day.

56. In due course, defendant Smith went by Farah’s cell to check on him in light of

defendant Ketema’s report. Farah was lying on the cell floor near the door, facing the back wall.

He wordlessly declined to have defendant Smith take his vital signs. She offered Farah nothing to

drink. Defendant Smith did not otherwise attempt to make, arrangements for Farah to be

examined, tested, seen by a doctor, or hospitalized.

57. Defendant Smith denies (sic) that she was neither trained nor permitted to judge the

-15-
 Case 1:10-cv-01012-GBL -IDD Document 197-1 Filed 04/07/11 Page 16 of 25

relative severity of Farah’s condition without first conducting an examination sufficient to permit

her to make such a judgment.

58. During the entire period of his incarceration, January 10-23, 2008, Farah was never

seen by a CCS doctor.

59. Defendant Smith wrote no note appearing in Farah’s chart memorializing her dealings

with him on January 21. She “cannot recall” why she failed to do so. While CCS later informed

the sheriff that defendant Smith had been counseled for this failure of documentation, there is no

documentation to that effect in defendant Smith’s file, and DON Lewis knows of no such

counseling.

60. Excessive electrolyte levels caused by dehydration can cause death. Tests were at all

times available to check the level of electrolytes in inmates requiring such testing. Such testing

would have confirmed the immediate need for emergency hydration. Neither defendant Ketema

nor defendant Smith took any steps to propose or secure electrolyte (or other medical) testing for

Farah.

61. STAT (i.e. immediate) laboratory work was supposed to be available for jail patients

when needed, as part of the contracted-for services CCS committed to deliver. CCS and former

HSA Brinkley contend however, that CCS “did not have the capacity to perform” STAT

laboratory work.

62. Had Farah been properly treated and hydrated on January 21 or 22, 2008, it is

“overwhelmingly likely” that he would not have died of dehydration on January 23. No evidence

has been proffered to suggest the contrary.

63. Both defendants Ketema and Smith, as well as numerous other CCS nurses who

-16-
 Case 1:10-cv-01012-GBL -IDD Document 197-1 Filed 04/07/11 Page 17 of 25

attended Farah, recognized that the necessary thing to do with a patient who failed to eat for two

days, was experiencing nausea and vomiting with no food in the vomitus, was calling for

something to drink, “an I.V.,” and for a doctor, having dry and discolored skin, being weak to the

point of being unable to stand, and otherwise exhibiting the signs of dehydration, was to call the

doctor.

64. Were a mental health patient not to take his medication, it was the responsibility of

CCS staff to refer the patient to the psychiatrist for appropriate action. Were the patient to

deteriorate physically, CCS staff was required to report this to the medical doctor as well. This

was a matter of “medical obligation.” In Farah’s case at hand, it was a deputy, not a nurse, who

apparently put Farah on call to see a doctor when he came in two days, by which time Farah was

dead.

65. Code of Va. §37.2-1000 et seq. permits the judicially authorized forcible psychotropic

medication of a mentally ill person incapable of making a competent decision to accept treatment.

There is, however, no reason to believe that Farah would have rejected hydration on January 21,

since his very request was for “a doctor and an IV.”

Farah’s Death

66. The day before he died, a CCS nurse offered Farah his medication only once. The

reason it was not offered a second time that day, as prescribed, is nowhere to be found. Nurse

McCarthy, who brought the Seroquel, knew that Farah had failed to take it from her several times

– concededly an unusual situation in this nurse’s experience. Yet she did nothing. She did not

approach him or attempt to speak with Farah, who was on his bunk, non-responsive. She did not

ask or undertake to examine him. The deputy called out “Farah come get your medication,” then

-17-
 Case 1:10-cv-01012-GBL -IDD Document 197-1 Filed 04/07/11 Page 18 of 25

“The deputy close[s] the door and you go to the next place.” Less than 24 hours later, Farah was

dead.

67. In the early morning of January 23, 2008, a guard, concerned with Farah’s breathing,

called for a nurse. Defendant Ketema responded to Farah’s cell. She came without any medical

equipment. She did not provide any guidance or direction to the deputies trying to save Farah’s

life by means of cardio-pulmonary resuscitation. She was, by her own admission, in shock and

“traumatized.”

68. Farah was brought to the Alexandria Hospital by emergency medical technicians

responding to a 911 call made by deputies over defendant Ketema’s advice that it was

unnecessary. He died shortly thereafter, of dehydration.

69. Pursuant to company protocol, CCS personnel conducted a formal mortality review of

Farah’s death on February 20, 2008. As a “description of medical state just prior to death,” the

resulting CCS form submitted by HSA Brinkley to CCS reads, “Patient had no reported or

documented medical problems.”

70. Within days of Farah’s death, CCS employees conducted a review of the CCS

program at the jail, giving rise to a “comprehensive” report. The report was a paean of praise by

CCS about CCS. Notwithstanding the failure to staff as contracted (e.g., posting an RN at night),

there was no problem found with staffing. Notwithstanding the absence of orientation checklists

from the files of multiple LPNs, there was no problem found with the orientation checklists. The

report identified no problems with health assessment and medical record keeping,

notwithstanding that discovery into a single patient’s chart has revealed a host of problems. It is

conceded that this patient was not singled out for non-compliant charting, nor is there any such

-18-
 Case 1:10-cv-01012-GBL -IDD Document 197-1 Filed 04/07/11 Page 19 of 25

claim. As for Farah’s death literally days before the review took place, the report remarks: “The

clients are somewhat concerned (sic) with the recent death of an inmate, but are waiting for the

autopsy report.”

71. The CCS director in charge of investigating inmate deaths for CCS was Jon Bosch, a

company vice president who was also Chief of Institutional Operations at CCS. He was “on the

team for implementing the program” in Alexandria. He generated no report on Farah’s death, and

knows of none. He was ignorant of: defendant Ketema’s actions on January 23; whether the

jail’s videotapes of Farah and his nurses had been reviewed; why defendant Ketema had been

fired and CCS documentation regarding same; who an unidentified “problem nurse” was;

defendant Smith’s dealings with Farah and any problems associated therewith; when “basic

training” had allegedly been given to the nurses; how the CSB maintained its records; whether

RNs were consistently absent at night; whether there was documented training on the automatic

defibrillator, and whether there were times when Farah’s chart was improperly maintained. One

thing Mr. Bosch did know, however: “[HSA] Merry [Brinkley] did not trust her staff to do stuff.”

72. During the period of his incarceration in January, 2008, Farah was not of “sound

mind” or was “insane” within the meaning of Fines v. Kendrick, 219 Va. 1084 (1979) and Hill v.

Nicodemus, 979 F.2d 987 (4th Cir. 1992).

73. All inmates’ medical care in the jail was the financial obligation of defendant CCS.

Defendant CCS, a profit-making entity, constantly recalled to its staff the need to stay within

budget. CCS’s policy in this regard, which occasionally inhibited proper treatment, was noted by

non-CCS personnel at the jail. The implementation of this policy by CCS fostered a corporate

-19-
 Case 1:10-cv-01012-GBL -IDD Document 197-1 Filed 04/07/11 Page 20 of 25

culture that facilitated defendants’ deliberate indifference to the palpable and serious medical

needs presented by Farah in January 2008, as set forth above.

74. The gross lapses in professional judgment and performance demonstrated by

defendants Ketema and Smith set forth above arose from defendant CCS’s deliberate indifference

to the foreseeable consequences, in the form of injury to inmate patients, of failing properly to

train and supervise its nurses.

75. As a result and as an exemplification of the deliberate indifference set forth above,

Farah, manifestly ill as he visibly was, was permitted to waste away and die, while being seen

twice daily by CCS nurses. Severe dehydration is painful and debilitating, and Farah suffered

greatly before he finally lapsed into unconsciousness. This result could and would have been

avoided had defendants acted consistently with their constitutional, contractual and professional

duties.

Timeliness

76. This action is timely, having previously been brought in Alexandria Circuit Court on

January 6, 2010 and nonsuited on March 30, 2010.

Causes of Action

Count I: Wrongful Death: All Defendants

77. By reason of their actions and inactions set forth above, defendants Ketema

and Smith are liable for the wrongful death of Farah Salem Farah. Plaintiff, the court-appointed

administrator of his estate, is entitled to an award of damages under Code of Va. §8.01-52 against

-20-
 Case 1:10-cv-01012-GBL -IDD Document 197-1 Filed 04/07/11 Page 21 of 25

them payable to Farah’s beneficiaries designated by Code of Va. 8.01-53(A)(ii), Farah having left

no spouse or child. These beneficiaries are Farah’s parents, Fatoum Assowe and Saleh Farah, and

his siblings Ali Farah, Ayan Farah, Marian Farah, Obah Farah Walker and Saada Farah. Each has

suffered sorrow and mental anguish and loss of society, companionship, comfort, guidance and

kindly offices from Farah, among other losses cognizable under law. Under the theories of

respondeat superior, agency and non-delegable duty, defendant Correct Care Solutions, L.L.C. is

liable for these damages, and any others proximately caused by the negligence, gross negligence

or deliberate indifference to Farah displayed by any other CCS employee or agent who had

contact with him in his last days of life .

78. Wherefore, plaintiff Obah Farah Walker, administrator of the estate of the late Farah

Farah, seeks an order of this court awarding actual damages and punitive damages against all

defendants, jointly and severally, in amounts appropriate to the proof at trial, to the benefit of

Farah’s statutory beneficiaries, his parents and siblings, plus her costs and such other relief as is

just.

Count II: Violation of Eighth Amendment: Defendant Ketema

79. By her actions and inactions set forth above, defendant Ketema, while

acting under color of state and local law in the discharge of the government’s obligation to

provide necessary health care to incarcerated persons, was deliberately indifferent to the dire,

palpable and undeniably serious medical needs of Farah, and his attendant pain and suffering,

thereby violating Farah’s rights under the Eighth Amendment of the United States Constitution, to

his severe injury during his lifetime.

-21-
Case 1:10-cv-01012-GBL -IDD Document 197-1 Filed 04/07/11 Page 22 of 25

-22-
 Case 1:10-cv-01012-GBL -IDD Document 197-1 Filed 04/07/11 Page 23 of 25

80. Wherefore, plaintiff Obah Walker, administrator of the estate of the late Farah Saleh

Farah, seeks an order of this court awarding the estate damages against defendant Ketema for

Farah’s pain and suffering in the Alexandria Adult Detention Center prior to his death, in an

amount appropriate to the proof at trial; punitive damages in an amount appropriate to the proof at

trial; her costs, including reasonable attorney’s fees; and such other relief as is just, including

declaratory relief.

Count III: Violation of Eighth Amendment: Defendant Smith

81. By her actions and inactions set forth above, defendant Smith, while

acting under color of state and local law in the discharge of the government’s obligation to

provide necessary health care to incarcerated persons, was deliberately indifferent to the dire,

palpable and undeniably serious medical needs of Farah, and to his attendant pain and suffering,

thereby violating Farah’s rights under the Eighth Amendment of the United States Constitution, to

his severe injury during his lifetime.

82. Wherefore, plaintiff Obah Walker, administrator of the estate of the late Farah Saleh

Farah, seeks an order of this court awarding the estate damages against defendant Smith for

Farah’s pain and suffering in the Alexandria Adult Detention Center prior to his death, in an

amount appropriate to the proof at trial, punitive damages appropriate to the proof at trial, as well

as her costs, including reasonable attorney’s fees, and such other relief as is just, including

declaratory relief.

-23-
 Case 1:10-cv-01012-GBL -IDD Document 197-1 Filed 04/07/11 Page 24 of 25

Count IV: Violations of Eighth Amendment: Defendant CCS

(a) Denial of Medical Care

83. By disclaiming responsibility for Farah as a CSB patient, not a CCS patient, and acting

accordingly as set forth above, through its various employees and agents whose actions it has

defended and ratified, defendant CCS denied Farah the medical care that he needed to contend

with his serious medical condition clearly apparent by the morning of January 21, 2008, when

defendant Ketema saw him as set forth above. This policy of non-responsibility for CSB patients

caused Farah his life within 48 hours. CCS’s policy was in stark derogation of its obligation –

constitutional as well as contractual and professional – to provide necessary medical care to all

jail inmates facing serious medical problems, as Farah did. CCS thereby exhibited deliberate

indifference to the medical needs of CSB clients, including specifically Farah, whose needs were

serious and apparent, in violation of the Eighth Amendment of the United States Constitution.

(b) Failure to Train and Supervise

84. By reason of the failures to train and supervise its nursing staff set forth above, where

the need for such training was obvious, where its absence was calculated to lead to injury and

constitutional deprivation to inmate patients, and where such resulting injury and deprivation in

fact occurred to Farah, all as set forth above, defendant CCS violated Farah’s rights under the

Eighth Amendment of the United States Constitution.

85. Wherefore, plaintiff Obah Walker, as administrator of the Estate of Farah Saleh

Farah, seeks an order of this court awarding the estate damages for Farah’s pain and suffering in

the Alexandria Adult Detention Center prior to his death against defendant CCS in an amount

-24-
 Case 1:10-cv-01012-GBL -IDD Document 197-1 Filed 04/07/11 Page 25 of 25

appropriate to the proof at trial, punitive damages appropriate to the proof at trial, as well

as her costs, including reasonable attorney’s fees, and such other relief as is just, including

declaratory relief.

Ms. Walker requests trial by jury.

Respectfully submitted,

OBAH FARAH WALKER, Administrator

of the Estate of the late Farah Saleh Farah,

By counsel

Dated: April 7, 2011

Counsel for plaintiff:

//s// Victor M. Glasberg

Victor M. Glasberg, #16184
Victor M. Glasberg & Associates
121 S. Columbus Street
Alexandria, VA 22314
(703) 684-1100 / Fax: 703-684-1104
vmg@robinhoodesq.com
WalkerObah\Pleadings\AmComplaint#2

//s// Steven E. Robertson

Steven E. Robertson, #78984
Covington & Burling, LLP
1201 Pennsylvania Avenue, N.W.
Washington, DC 20004
(202) 662-5993 / Fax: 202-778-5993
srobertson@cov.com

-25-