$26.75 Million Federal Verdict for Cindy Lou Hill's Death in the Spokane County Jail, With the $24 Million Punitive Award Later Vacated on Appeal

Cindy Lou Hill was arrested on August 21, 2018, for possession of heroin and booked into the Spokane County Jail. She was 55 years old. Four days later, on August 25, her cellmate found her on the floor of their cell in the fetal position, screaming and unable to move. A nurse employed by NaphCare, the Alabama company Spokane County paid to run medical care inside the jail, came to examine her. Hill's cellmate had to drag her across the floor so the nurse could reach her.

The nurse attributed Hill's symptoms to heroin withdrawal. No physician examined her, no one sent her to a hospital, and no diagnostic testing was done. Hill was instead placed in a medical watch cell, where monitoring fell to jail guards with no medical training. She was found dead there at 5:25 that evening. An autopsy determined that her duodenum had ruptured and that bacteria leaking into her abdomen caused a fatal infection. It was a treatable surgical emergency that was never treated.

Edwin Budge and Erik Heipt of the Seattle civil rights firm Budge & Heipt filed suit for Hill's estate in the United States District Court for the Eastern District of Washington, case 2:20-cv-00410. The estate alleged that NaphCare and Spokane County deprived Hill of her Fourteenth Amendment right to adequate medical care and that NaphCare's staff was negligent in failing to recognize and respond to an obvious emergency.

On July 20, 2022, the jury in Spokane returned its verdict: $2.75 million in compensatory damages, made up of $2 million for Hill's pain and suffering and $750,000 for her loss of enjoyment of life, with fault apportioned 90 percent to NaphCare and 10 percent to the county. The jury added $24 million in punitive damages against NaphCare alone, bringing the total award to $26.75 million. The verdict drew attention well beyond the courtroom. Spokane County approved new funding to increase medical staffing at the jail and later parted ways with NaphCare as its jail medical provider.

The punitive award did not survive appeal. In April 2025, a Ninth Circuit panel affirmed the liability findings and the compensatory award, writing that the jury could reasonably conclude NaphCare routinely sent people with serious, potentially fatal conditions to medical watch for monitoring by medically untrained guards. But the panel held that the $24 million punitive award, nearly nine times the compensatory figure, exceeded constitutional due process limits. It vacated the punitive damages and remanded with instructions that any new award not exceed a four to one ratio to compensatory damages, a ceiling of $11 million.

A new punitive award was never litigated. Back in the district court, the parties reached a resolution whose terms were not disclosed. On June 18, 2025, the court granted their stipulated motion to dismiss, closing the case.