United States District Court, S.D. Indiana, Indianapolis Division
ESTATE OF TAMMY PEREZ by its administrator, SHERYL PEREZ, Plaintiff,
MORGAN COUNTY SHERIFF, ADVANCED CORRECTIONAL HEALTHCARE, INC., ANITA BURNAM, RACHEL MUNDY, CHRISTINA ANDERSON, BOBBIE ANTHIS, MALLORY SCHWAB, ERIC MULLIKIN, VIENNA MARTIN, JARED SMITH, KRIS DARLING, ROBERT ANDREWS, DR. RONALD EVERSON, BRIGHTON SICHTING, ANDREW MOORE, NICHOLAS SMITH, Defendants.
MEMORANDUM ORDER ON DEFENDANTS' MOTIONS FOR
SUMMARY JUDGMENT (DKT. 84) AND PARTIAL SUMMARY JUDGMENT (DKT.
EVANS BARKER, UNITED STATES DISTRICT JUDGE.
Perez (“Tammy”) died on October 1, 2015, after
three days' confinement in the Morgan County jail
(“the Jail”). Plaintiff, Tammy's estate
(“the Estate”), by her mother Sheryl Perez
(“Sheryl”) in her capacity as personal
representative of the Estate, sued defendants Morgan County
Sheriff in his official capacity (“the Sheriff”),
Advanced Correctional Healthcare, Inc. (“ACH”),
the Jail's private healthcare contractor, one Jail
doctor,  two Jail nurses,  four Jail medical officers,
seven Jail officersunder 42 U.S.C. § 1983 for violations
of the Eighth Amendment and state-law negligence.
before the Court are the Motion for Summary
Judgment, Dkt. 84, filed by the Sheriff, the Jail
nurses, the Jail medical officers, and the Jail officers
(together, “the Morgan County Defendants”), and
the Motion for Partial Summary Judgment, Dkt. 87,
filed by ACH and the Jail doctor (together, “the ACH
Defendants”), seeking judgment on the Estate's
federal claims only.
Estate concedes that, of the Morgan County Defendants, two
Jail medical officers and four Jail officers are entitled to
judgment in their favor. Pl.'s Resp. Br. Opp. Mots. Summ.
J. (Dkt. 97) 2-3. The Morgan County Defendants' motion
is therefore granted as to those defendants without further
discussion. For the reasons below, as to the remaining Morgan
County Defendants, their motion is granted in part and denied
in part. The ACH Defendants' motion is granted in part
and denied in part. The bases for these rulings are
and Procedural History
state the facts and the inferences from them in the light
most favorable to the nonmovant, the Estate. The following
account is therefore necessarily one-sided. “We do not
vouch for the objective truth of every detail of the
following account [n]or take any position as to [the
Estate]'s ultimate chance of success on the
merits.” Berry v. Peterman, 604 F.3d 435, 438
(7th Cir. 2010).
Tammy's Background: August 11, 1981, to September 27,
was born on August 11, 1981, with “congenital adrenal
hyperplasia due to adrenal steroid 21-hydroxylase
deficiency[, ]” Dkt. 96 Ex. 2 (Schnall Rep.), at 2,
“the most common form of congenital adrenal
hyperplasia.” Id. at 4. Deficiency of
21-hydroxylase depresses the production of certain critical
steroids by the adrenal glands. In Tammy's case, this
steroid imbalance during prenatal development meant
“[s]he was a girl getting more male hormone, so when
she was born, her private area was not as it should have
looked.” Dkt. 86 Ex. 1 (Sheryl Dep.) 42:3-5. As a
result, Tammy had “maybe 10” genital
reconstruction surgeries during her life. Id. at
a result of her adrenal hyperplasia, Tammy “required
daily hormone replacement therapy to prevent cardiovascular
collapse/arrest.” Dkt. 96 Ex. 4 (Sozio Rep.), at 2.
More specifically, adrenal hyperplasia due to 21-hydroxylase
may occur in a ‘classical' or
‘non-classical' form. The majority of patients with
the classical form become very ill within 24 to 48 hours if
deprived of their steroid replacement medication . . ., and
develop severe dehydration and electrolyte imbalances, often
resulting in death. Patients with the non-classical form . .
. can often tolerate being off steroid replacement medication
for several days without any serious medical consequences, as
long as they are not under any abnormal physical stress.
Physical stress causes the body to need higher than normal
amounts of adrenal steroids.
Dkt. 96 Ex. 2 (Schnall Rep.), at 4. The adrenal glands of
adrenal hyperplasiacs “who have taken adrenal steroids
chronically . . . lose the ability to automatically
produce” the higher steroid levels required by the body
under stressful conditions, id., requiring
“double or triple” the ordinary dose of
replacement steroid. Dkt. 96 Ex. 6 (Gavin Dep.) 17:12. The
classical form may be further divided into
“salt-wasting” and “non-salt-wasting”
forms, of which the salt-wasting form is the more severe,
id. at 35:4-6, apparently depending on whether the
patient's adrenal insufficiency requires replacement of
both aldosterone and cortisol, in the salt-wasting form, or
of cortisol only, in the non-salt-wasting form. See
Dkt. 96 Ex. 3 (Schnall Dep.) 27:1-28:23.
appears to have had classical adrenal hyperplasia, which may
have transitioned in her youth or early adulthood from the
salt-wasting to the non-salt-wasting form. Id. at
27:9-14. For her steroid replacement therapy, “[d]uring
[Tammy's] late teenage years her primary adrenal steroid
medication was changed from hydrocortisone to dexamethasone .
. . [, ]” Dkt. 96 Ex. 2 (Schnall Rep.), at 2, and Tammy
remained on dexamethasone until her death. Tammy and Sheryl
“were advised by [Tammy's] endocrinologists that
she could die of adrenal crisis if her steroid replacement
was not maintained adequately.” Id. Sheryl was
convinced of the importance of Tammy's dexamethasone and
ensured that Tammy took it regularly, even after Tammy had
moved out of Sheryl's house at age 18. Tammy kept her
dexamethasone at home and in her purse, and Sheryl would keep
a few pills from each prescription refill at her own house,
in case Tammy needed them there.
also suffered from fibromyalgia and arthritis in her back and
hands, and “always told [Sheryl] her whole body
hurt.” Dkt. 86 Ex. 1 (Sheryl Dep.) 109:1-2. By 2010,
while living in Bloomfield or Bloomington, Indiana, Tammy was
seeking pain treatment from a doctor in Terre Haute, Indiana,
who “pushed pills.” Id. at 79:22. In
2011, she reported that “[n]othing [took] [her] pain
away. Taking [her] meds help[ed] and taking hot baths
sometimes.” Id. at 87:11-12. Tammy would often
take hot baths or hot showers to alleviate pain and
discomfort. By 2013, Tammy was “taking opiates
chronically for back pain.” Id. at 99:18.
Around the same time, Sheryl began to suspect that Tammy was
a “chronic substance abuser[.]” Id. at
78:9-11. Eventually Tammy admitted to Sheryl to using heroin.
saw Tammy suffer from heroin withdrawal “[m]aybe twelve
times.” Id. at 96:25. Sheryl went with Tammy
to the hospital for Tammy's withdrawal “maybe six
or seven times.” Id. at 96:19. Sheryl observed
that Tammy's withdrawals appeared to have
“different levels.” Id. at 97:22. At
their mildest, Tammy's withdrawals caused her to feel
“sick” and “irritable . . . .”
Id. at 98:1. At their severest, Tammy would
“throw up and couldn't get it to stop.”
Id. at 98:7-8. “If [Tammy's vomiting]
continued for maybe three or four hours and [Sheryl]
couldn't get her to stop[, ]” Sheryl would take
Tammy to the hospital. Id. at 98:11-12. For that
reason, Sheryl never saw Tammy go through severe withdrawal
for more than one day. Id. at 169:13-14. Sheryl and
Tammy understood that Tammy was supposed to “double up
on her [d]examethasone” when Tammy's vomiting was
severe, id. at 105:18-23, and Tammy's ability to
keep the medication down during these episodes “was
always [Sheryl's] main concern.” Id. at
108:21. When Tammy was treated by emergency room doctors at
her hospital visits for severe vomiting and nausea, they
“treated her with either IV fluids or with anti-nausea
medication in an other-than-oral route.” Dkt. 96 Ex. 3
(Schnall Dep.) 44:18-20. In at least one instance, Tammy was
given her dexamethasone intravenously as well. The
hospitals' treatment of Tammy was thus “effective
for dehydration and adrenal insufficiency, in every
instance” for which there is record evidence.
Id. at 47:21-22.
March 7, 2015, Tammy was arrested for possession of a
narcotic drug and three related offenses, and, after three
days in the Jail, was released pending trial. She agreed to
plead guilty to the possession charge in exchange for
dismissal of the balance. Tammy's case was set for a
sentencing hearing on September 28, 2015. The night before,
September 27, 2015, Tammy used heroin for the last time,
expecting, on the advice of her lawyer, to be sentenced to
home detention rather than incarceration.
Tammy's First Day in Jail: September 28, 2015
morning of Monday, September 28, 2015, Morgan Superior Court
imposed a 547-day sentence on Tammy, 90 days executed and 457
days suspended to probation. The abstract of judgment noted
that Tammy's “[e]xecuted time may be spent in in
patient [sic] treatment facility upon
admission[.]” Dkt. 86 Ex. 1 (Sheryl Dep. Ex. 44), at
35. As Tammy's incarceration was unexpected, neither
Sheryl nor Tammy had brought Tammy's medication to the
sentencing hearing. Once Tammy had been remanded to the
Sheriff's custody, Sheryl went to Tammy's house and
picked up her medications, including her dexamethasone.
Sheryl brought them to the Jail before noon and asked to
speak with a nurse or a doctor.
spoke with Anderson, the on-duty Jail medical officer,
Nurse Burnam, the on-duty Jail nurse. At the time, Anderson
worked the Jail's day shift, from 8:00 a.m. to 4:00 p.m.,
on weekdays, and Nurse Burnam worked a similar shift,
weekdays from 8:00 a.m. to 4:00 p.m., or from 9:00 a.m. to
5:00 p.m. Sheryl had brought four medications for Tammy and
delivered them to Nurse Burnam. Sheryl made clear to Nurse
Burnam that she “didn't care if [Nurse Burnam] gave
[Tammy] the other[s] . . ., ” but that Tammy “had
to have [the dexamethasone] every single day.” Dkt. 86
Ex. 1 (Sheryl Dep.) 185:21-24. Nurse Burnam acknowledged
Sheryl's directive and “assured [her] that they
knew that [Tammy] had to have that medicine.”
Id. at 187:1-2. Sheryl “went into detail about
what the issue was” that necessitated the
dexamethasone, though Anderson could not later recall
“that [Tammy's having an adrenal gland disorder]
was exactly what it was.” Dkt. 86 Ex. 10 (Anderson
then called Dr. Everson, the Jail doctor, who was not on duty
at the Jail that day, and requested approval to administer
the four medications to Tammy. Dr. Everson approved three of
the medications, including the dexamethasone, but not the
fourth, mirtazapine, “a mental health medication,
usually . . . used to treat depression, sometimes . . . used
. . . as a sleeping pill.” Dkt. 86 Ex. 5 (Everson Dep.)
45:7-9. Anderson began a Medication Administration Record
(“MAR”) “that would document when Tammy . .
. would receive scheduled medication in the [Jail].”
Dkt. 86 Ex. 8 (Burnam Aff.) ¶ 4.
10:00 a.m., September 28, 2015, Martin, a Jail officer,
recorded an assessment of Tammy. Martin noted that Tammy
“appear[ed] to be under the influence of heroin”
and admitted using heroin the night before. Dkt. 86 Ex. 6
(Mundy Dep.) 48:18- 19. Tammy also admitted to Martin that
she was dependent on heroin, which Martin recorded. Martin
recorded further that Tammy reported taking two medications,
dexamethasone and Suboxone, a drug used to treat opioid
addiction, though Suboxone was not among the medications
Sheryl had delivered to the Jail for Tammy.
Martin completed Tammy's book-in procedure, Tammy was
placed in cell R2, a cell near the Jail's receiving area
known as the women's “drunk tank.” Dkt. 86
Ex. 12 (Martin Dep.) 8:9-16, 11:9-23.
Tammy's Second Day in Jail: September 29, 2015
4:30 a.m., Tuesday, September 29, 2015, Tammy called Sheryl
for Tammy's Jail-allotted twelve-second phone call. Tammy
asked Sheryl to pick up her Suboxone prescription. Sheryl
asked, “What about rehab?” Dkt. 86 Ex. 1 (Sheryl
Dep.) 38:22. Tammy told Sheryl not to worry and that Tammy
would “take care of it in here.” Id. at
38:24. Tammy sounded “[g]roggy, like somebody that
just, you know, woke up, wasn't feeling well.”
Id. at 39:20-21. It would be the last time Sheryl
spoke with her daughter.
8:00 a.m., Nurse Burnam administered Tammy's
2:00 p.m. and 3:00 p.m., Stacey McLaughlin
(“McLaughlin”) was booked into the Jail. As her
book-in procedure was completed in the Jail's receiving
area, McLaughlin “could hear [Tammy] retching from the
outside[;] [McLaughlin] could hear [Tammy] being violently
ill when [McLaughlin] was outside when [she] had just arrived
there. . . . And [McLaughlin] could hear someone being
violently ill over and over again and then [the Jail
officers] moved [McLaughlin] into that cell [R2].” Dkt.
96 Ex. 8 (McLaughlin Dep.) 14:25-15:5. When McLaughlin
entered the cell, “Tammy was somewhat coherent . . .
.” Id. at 14:24. But “[w]ithin an hour
she was incoherent, [and] could not talk anymore.”
Id. at 15:6-7.
“was too sick” to make any introductions.
Id. at 23:9. “[S]he mumbled and said something
like she was really ill . . . .” Id. at
23:9-10. McLaughlin found it difficult to concentrate on
Tammy's plight at first because McLaughlin was “a
little disgusted” that she had been put into a cell
with “vomit on the wall” and a person who
“c[ould]n't get up to vomit into . . . the toilet .
. . in very close quarters.” Id. at 23:5-6,
the afternoon, prior to the inmates' supper being served,
as observed by McLaughlin and her fellow inmate in R2
Michelle Rose (“Rose”), Tammy continued to
[Tammy] just was getting sicker. She wasn't talking as
much. The vomiting was really bad. She would knock on the
door, we would knock on the door saying she needed help. At
one point it was a mess. I mean there was vomit on the walls,
there was vomit on the floor, there was vomit on the mats,
you know, and we are all exposed to this. . . . [I]t was very
apparent this young woman needed to go to the hospital . . .
Id. at 25:2-13.
4:50 p.m., Tammy was examined by Nurse Burnam. Tammy
complained to Nurse Burnam of suffering from heroin
withdrawal. Specifically, Tammy's “subjective
complaint was heroin withdrawal and she had been vomiting for
. . . one to two hours[.]” Dkt. 86 Ex. 5 (Everson Dep.)
34:11-13. Nurse Burnam recorded her objective assessment of
Tammy as follows: “stomach hurts, diarrhea, slightly
dehydrated, skin clammy, mostly dry heaves, small amount of
yellow stomach bile present.” Id. at 34:16-18.
Nurse Burnam assessed Tammy's dehydration by a skin
turgor test, that is, Nurse Burnam “pulled the skin up
on [Tammy's] hand and it was a little slow going
down.” Dkt. 86 Ex. 4 (Burnam Dep.) 13:22-23.
Tammy's blood pressure was 118/78; her pulse was 82 beats
per minute; and her temperature was 97.6 degrees Fahrenheit.
Burnam, who, as a nurse, was not authorized to prescribe
medications, called Dr. Everson, who was not at the Jail that
day, and reported her findings and assessment. Dr. Everson
agreed that Tammy was suffering from heroin withdrawal and
ordered a “withdrawal protocol, which consisted of a
one time dose of [P]henergan and administrations of
[V]istaril and [B]entyl, twice a day for five days.”
Dkt. 86 Ex. 1 (Burnam Aff.) ¶ 6. Those medications,
among other effects, “help with nausea, vomiting,
diarrhea[, ]” Dkt. 86 Ex. 6 (Mundy Dep.) 26:1, and were
pills to be taken orally. Nurse Burnam recorded that any
follow-up was to be at the “inmate's request[,
]” or, in other words, “[i]f Tammy felt like she
was getting worse, she was to let [Jail staff] know.”
Dkt. 86 Ex. 4 (Burnam Dep.) 14:16, 14:21-22. There was no
“plan to determine whether once [Tammy] took [the
withdrawal protocol medications] and . . . if she was still
vomiting whether she would be able to keep [the medications]
down[, ]” id. at 15:11- 14, though Nurse
Burnam understood that the medications would not have had
“any [e]ffect” on Tammy if she were unable to
keep them down. Id. at 15:16.
Nurse Burnam examined Tammy and the inmates had their supper
(excepting Tammy, who did not eat), Tammy's deterioration
Let me tell you something, I have never seen so much fluid
leave a body in my life. I don't want to get teary-eyed.
I have never seen anything like this. . . . They gave [Tammy]
a drink of water and she vomited. I mean a sip. And when she
vomited up, I mean they gave her a sip of water and she would
vomit up that much.
We were beating on the doors because she couldn't make it
to the trash can so then they brought her this sack. They
probably carried out four or five of those bags. And they
looked like giant colostomy bags when they were leaving. They
gave her medicine and we told them you can't give her
pills, she throws them up immediately. . . .
But they did let her out at one point because she lost
control of her bowels and she was laying down at one point
and she said, “Oh, no, ” and she knew that she
had lost control of her bowels so she started beating on the
door. . . . [I]t was very apparent this young woman needed to
go to the hospital and we told them that [after dinner].
Dkt. 96 Ex. 8 (McLaughlin Dep.) 23:20-24:16.
p.m., Nurse Mundy, the Jail nurse who worked the evening
shift, which lasted from approximately 4:00 p.m. or 5:00 p.m.
until approximately midnight (though Nurse Mundy usually left
around 10:00 p.m.), had relieved Nurse Burnam. Around 8:00
p.m., Nurse Mundy delivered Tammy's Vistaril and Bentyl:
[After dinner there was a medical pass] and they gave her a
pill. . . . And she immediately vomited it up. And at that
point we even told them she needs-I think at that point the
first medical pass, we told them she needed to go to the
hospital because she was getting dehydrated and that she
could not keep anything down. . . .
What [Jail staff] do is you pound on the door again and say
is [medical staff]-are they coming, and they say, yeah, we
let them know and then maybe an hour later someone might
come, or they may not.
[But] they came for the medical pass. And I am going to tell
you, the nurse person [Nurse Mundy] was very insensitive, she
was rude. She was like drink lots of fluid, here is some
Pepto Bismol, . . . and she was very rude. . . .
[S]he was exasperated and was like here is Pepto Bismol, here
is some water type thing.
Id. at 26:13-21, 29:8-17, 32:23-25. Nurse Mundy
later delivered Tammy's Phenergan, though that delivery
was not recorded on Tammy's MAR:
Later [Nurse Mundy] came [for a second medical pass] and she
may have given her I think it was Phenergan. I don't know
what it was, but it was in a pill form. [Tammy] threw it up.
[Nurse Mundy] came again because we pounded on the doors and
we tried to explain to her [that Tammy] needs to go to the
hospital and get a shot, she is throwing everything up, it is
doing no good. We told them-told [Nurse Mundy that Tammy]
can't even hold down a sip of water. If anything touched
her lips, a gallon of something came out. . . .
[T]here is no compassion when someone is going through
withdrawal. . . . [Nurse Mundy] was just being rude. . . .
You can be professional and you can be compassionate. It
doesn't mean you have to stroke their head or anything,
but you can be professional and you can be neutral, but you
can at one point just talk like someone is not a very nice
person and doesn't really deserve any treatment or help
and that's how [Nurse Mundy] addressed [Tammy]. . . . It
was worse than cold. Cold I understand. Cold is like trying
to remove yourself from the situation because it might bother
you or, you know, you just don't care. It was beyond
that. It was disdain. That's the best way I can describe
Id. at 32:25-33:8, 33:21-22, 34:2-10, 34:15-20.
Tammy's Third Day in Jail: September 30, 2015
Tuesday, September 29, 2015, passed into Wednesday, September
30, 2015, Tammy's condition continued to worsen:
Throughout-I mean, throughout the night later perhaps is when
she started, and it may have been early in the morning, like
I said, you lose time in [the Jail]. I mean she was getting
sicker and sicker. She moved to the floor by this time. I am
pretty sure she was lying on the floor. . . . [I]t is all a
blur at this point, but [Tammy] was getting more ill, she was
becoming more incoherent, but I could tell you at certain
points she was lying on the floor, she beat on the floor and
said, “Help me, help me.” She was lying on the
floor saying, “Help me, please. Help me. She was
begging for help . . . loud enough that they could have heard
Id. at 36:11-37:1. At some point Tammy abandoned her
efforts to vomit into a trash can or toilet and began to
“just turn her head . . . .” Id. at
38:24. “[A]ll of a sudden [McLaughlin] heard [Tammy]
go, ‘Oh, shit.' . . . [A]nd she said, ‘I shit
myself.' And she was really embarrassed and . . . that is
the first time she started pounding on the door . . . asking
to be cleaned up.” Id. at 39:13-17.
and J. Smith were Jail officers on the Jail's night
shift, which lasted from approximately 12:00 a.m. to
approximately 8:00 a.m. J. Smith was the shift supervisor and
Schwab's superior. No. nurses or doctors were on duty at
the Jail during the night shift.
reported by McLaughlin, “[a]t the point that [Tammy]
started losing control of her bowels, [Schwab] was nice
enough to take her out, let her take a shower.”
Id. at 37:5- 6. In fact, Tammy was allowed two
showers over the course of the night shift. As Rose observed,
“Tammy [had] los[t] control of her bodily functions and
. . . repeatedly soil[ed] herself and her clothing with her
own vomit and feces.” Dkt. 96 Ex. 9 (Rose Aff.) ¶
12. And Tammy “not only soiled herself and her clothes,
but also the cell area we shared.” Id. ¶
13. Accordingly, Schwab “removed Tammy from her cell,
took her to the shower so she could wash the vomit and feces
off . . . [, ] and returned her to the cell.”
Id. ¶ 14. But “[t]hese measures only
worked temporarily, as Tammy's nausea and diarrhea were
so bad that she quickly soiled her jail clothing.”
Id. ¶ 15.
Tammy's showers, Schwab observed Tammy “sitting
down in the shower just letting the water run over her after
she cleaned herself, . . . sitting there leaning against the
wall.” Dkt. 86 Ex. 11 (Schwab Dep.) 12:16-17, 12:21.
Eventually Schwab and J. Smith grew “a little
exasperated . . . and that's when they said this is the
last time, we can't do this again, you need to make it to
the toilet.” Dkt. 96 Ex. 8 (McLaughlin Dep.) 40:7-10.
“Try to make it to the toilet, you're an adult,
” Schwab told Tammy. Dkt. 86 Ex. 11 (Schwab Dep.) 12:3.
But Tammy could not, and “it happened again throughout
the middle of the night but no one let her clean herself up
that time.” Dkt. 96 Ex. 8 (McLaughlin Dep.) 40:10-13.
was “left . . . in her cell for hours in jail clothing
drenched in her own vomit and feces.” Dkt. 96 Ex. 9
(Rose Aff.) ¶ 16. During this time, Tammy was
“throwing up constantly, her eyes [were] starting to
sink back into her head, she look[ed] like she ha[d] lost 20
pounds, it [was] very apparent. She [was] mumbling, she
[could] barely speak at this point . . . .” Dkt. 96 Ex.
8 (McLaughlin Dep.) 40:22-41:1.
4:30 a.m., Tammy tried to call Sheryl again, as she had the
day before. But “you've got to go in there and pay
money to have your phone set up to receive phone calls [from
the Jail], and [Sheryl] hadn't done that.” Dkt. 86
Ex. 1 (Sheryl Dep.) 40:18- 21. Sheryl went to have her phone
set up that same day, but would not receive another phone
call from Tammy.
8:00 a.m., Nurse Burnam administered Tammy's
dexamethasone, Vistaril, and Bentyl orally. Around the same
time, Tammy's fellow inmates “told [Jail staff] you
are giving [Tammy] medicine and it is doing no good because
she throws it up.” Dkt. 96 Ex. 8 (McLaughlin Dep.)
49:3-5. Tammy did not eat breakfast.
9:00 a.m. and 10:00 a.m., now the Jail's day shift,
on-duty Jail officers removed Tammy from her cell for another
shower. This would be the last McLaughlin and Rose would see
of Tammy. “[A]t this point, [Tammy] looked really,
really bad. . . . That's when her eyes were sunken down
in the back of her head, everything.” Id. at
49:13-16. Tammy's vomiting and diarrhea had continued
unabated. Such was Tammy's distress that “when she
took a drink of water, she would vomit a little bit and then
she would spit it out and then she would take in her cup and
then she take another drink of water.” Id. at
43:21-24 (sic passim). McLaughlin was horrified and
disgusted. The volume of Tammy's vomiting and diarrhea
made McLaughlin shocked to learn “the human body had
that much ...