COUNCIL BLUFFS, IOWA — Kevin Pittillo was delirious, not wearing a shirt or jeans and claiming that he was a former KGB agent from Russia or a current member of the U.S. military, when he was hauled to the Pottawattamie County Jail in July 2018.

His offense: disturbing the peace.

Eleven days later, as he lay on the floor of his jail cell, nude and largely unresponsive, jailers called for an ambulance, saying his condition had worsened.

At an Omaha hospital, both of Pittillo’s legs were amputated after doctors diagnosed a “profound ischemia,” clotting that had blocked the flow of blood to his legs. A surgeon testified that one leg appeared dead.

After a Nebraska public guardian — assigned to take care of the mentally troubled 66-year-old — heard of the horrific case, she filed a negligence lawsuit over the lack of proper medical attention in jail.

The lawsuit led Pottawattamie County to reach a settlement of $4.5 million in November on behalf of the county jail staff, the Examiner learned, and also caused the jail’s supervising physician, Dr. Jon Thomas, to agree to an out-of-court settlement for an amount that was not disclosed.

On Tuesday, a jury in this Iowa city on Nebraska’s border began deliberating whether another defendant in the case, the psychiatrist who oversaw mental health care at the Pottawattamie County Jail, was also negligent.

The plaintiff’s attorney calculated that damages in the case could extend to $15 million to $30 million, due to Pittillo’s loss of his legs, his physical and mental pain and suffering, as well as 24-hour care for the rest of his life.

Lawyers for the psychiatrist, Dr. Ivan Delgado, meanwhile, said their client should not be held liable for the medical outcome when he was focused on his patent’s mental well-being. They scoffed at the estimate of damages, saying that it was inflated and that the goal of the lawsuit was “dollars.”

Michelle Chaffee, the director of the Nebraska Office of Public Guardian who was assigned to oversee Pittillo’s well being, said the case was another example of how people with mental illnesses don’t get the consideration and treatment they deserve.

“It’s heartbreaking,” Chaffee said. “All of these [mental health care] systems are so broken.”

Pittillo, who cannot get himself out of bed, now lives in an independent living facility in Omaha that has staff able to assist the amputee. He testified earlier in the six-day-long trial but did not attend closing arguments Tuesday afternoon.

It was the first time the guardian’s office had to file a lawsuit over medical care for a client, Chaffee said. More often, she said, the office is seeking justice in cases of financial exploitation or addressing medical mishandling through state licensure complaints.

But she said when she learned of the horrible outcome of the case, it was time to pursue legal action.

During closing arguments Tuesday in Pottawattamie County District Court, lawyers agreed it was a tragic case, but they disagreed about whether a jail psychiatrist should be held liable for diagnosing a medical problem.

Pittillo’s lead attorney, Gary Dickey of Des Moines, said Delgado, the jail psychiatrist, had failed to follow a standard “safety rule” of all psychiatrists, which is to transfer someone out of jail if the person is too sick to be there.

The Nebraska Office of Public Guardian was established in 2014 after a series of abuses were uncovered involving appointed guardians.

The office, which handles about 300 cases, takes over when there are no relatives, or anyone else, available to manage the affairs of an individual suffering from a handicap or old age.

In this case, the Nebraska office got the Pittillo case because his surgery was done in Omaha.

When Pittillo first arrived at the jail in July 2018, he was described as acting “strangely,” and refused to enter a holding cell, saying “I’ll be dead before morning. My bloodlines are known. …”

He was placed in a protective custody cell by concerned jailers “due to psychotic concerns” and was described as “delusional” and suffering from “hallucinations.”

By July 30, six days after he was jailed, Pittillo had not showered for days, smelled “very bad” and was confused and could not stand up on his own. Jailers had to shower him and assist him back to his cell.

By Aug. 2, jailers observed that Pittillo seemed “ill” and said he was getting worse as he lay on the floor of his cell, naked and almost nonverbal. He had a painful groin rash and needed a wheelchair to get to the jail shower. That’s when an ambulance was called, with Pittillo eventually landing at an Omaha hospital.

Dickey, Pittillo’s lead attorney, blamed Delgado, the jail psychiatrist, for not checking nurses’ logs that indicated Pittillo was regularly refusing to take his medication and for failing to monitor his care after prescribing Seroquel, which is used to treat schizophrenia and other mental illnesses.

In his own words, the plaintiff’s attorney said, Delgado admitted that Pittillo needed to be admitted to a mental hospital, saying, “Houston, there’s something wrong here,” after examining Pittillo on July 31, 2018.

“A reasonable psychiatrist would have consulted with a sheriff or warden and got him to a hospital,” Dickey said.

But Andrew Efaw, a Denver lawyer who handled closing arguments for Delgado, said there was no such thing as a “safety rule” but an obligation for the psychiatrist to follow a reasonable standard of care, which he said Delgado did.

Efaw pointed to testimony during the trial by one expert witness — one plaintiff’s lawyers described as not credible — who said Pittillo suffered from lifelong medical issues, such as heavy smoking and a family history of blood clots, that contributed to the rapid onset of the blood clotting. days after Pittillo was jailed.

Efaw also said jail nurses did not inform the psychiatrists for a week that Pittillo was refusing to take his medication. Ensuring that an inmate is taking meds is the job of the nurses, not the doctor, he said.

“Brutal honestly requires justice for this man,” Efaw said as he stood behind Delgado at the defense table, “and requires a finding of no liability. I don’t believe this is even a close case.”

 “Sometimes bad things happen, and it’s not anyone’s fault,” he added.

The jury of six men and two women left the courthouse Tuesday evening shortly after closing arguments concluded about 6:30 p.m.

This story was originally published by Nebraska Examiner, an editorially independent newsroom providing a hard-hitting, daily flow of news. It is part of the national nonprofit States Newsroom. Find more at nebraskaexaminer.com.

Author Profile: Paul Hammel