Evaluation of Alleged Violations of a Pretrial Detainee's Right to Adequate Medical Care Requires Objective Deliberate Indifference Standard
In Gordon v. County of Orange, 888 F.3d 1118 (9th Cir. 2018), the Ninth Circuit Court of Appeals reviewed the decision by the U.S. District Court for the Central District of California regarding the death of a pretrial detainee. The successor-in-interest to the detainee brought a 42 U.S.C. § 1983 (1996) action against jail staff, county, and other entities, alleging that the detainee's right to adequate medical care had been violated under the Fourteenth Amendment's due process clause. The district court granted summary judgment in favor of the defendants. On appeal, the Ninth Circuit held that claims for violations of the right to adequate medical care for pretrial detainees made under the Fourteenth Amendment should be evaluated under an objective deliberate indifference standard.
Facts of the Case
Matthew Gordon was arrested by the Placentia Police Department on heroin-related charges on September 8, 2013, and taken to the Orange County Men's Central Jail. Nurse Debra Finley conducted an intake evaluation of Mr. Gordon and learned that he had been using heroin daily. Ms. Finley used the Clinical Institute Withdrawal Assessment for Alcohol (CIWA) to evaluate Mr. Gordon's heroin withdrawal, rather than the county's Clinical Opiate Withdrawal Scale (COWS) assessment form.
Ms. Finley then consulted with Dr. Thomas Le, who issued an Opiate Withdrawal Order for Mr. Gordon and ordered that he be placed in regular housing rather than the medical unit. On Mr. Gordon's paperwork, Dr. Le apparently crossed out the statement “COWS and Vital Signs on admission and daily x 5” under the heading Nursing Detox Assessments, and instead wrote “CIWA x 4 days” (Gordon, p 1121).
Approximately ten hours later, Mr. Gordon was placed in general population. Another detainee observed that Mr. Gordon vomited continuously for 30 to 45 minutes. On September 9, 2013, at approximately 8:30 a.m., Mr. Gordon was transferred to Module C, Tank 11, along with a “module card” indicating that he was in need of medical attention. While there, Nurse Brianne Garcia administered medications to Mr. Gordon. Deputy Robert Denny conducted three welfare checks of Module C during the evening, which involved direct visual observation of each inmate from a corridor that was twelve to fifteen feet away and elevated approximately six feet above the Tank 11 floor. Evidence also suggested that visibility was obscured by a glass corridor. Deputy Denny acknowledged that he was unable to determine if a detainee was alive, breathing, or showing “potential indicators” of distress from the viewing area.
At approximately 10:46 p.m. on September 9, 2013, inmates yelled “man down,” indicating that Mr. Gordon was in distress. Deputy Denny arrived a couple of minutes later and found Mr. Gordon unresponsive. Medical staff members arrived shortly thereafter and administered care. At 11:00 p.m., Mr. Gordon was transferred to a local hospital and pronounced dead.
Mary Gordon, successor-in-interest for Mr. Gordon, sued individual defendants Mr. Denny, Ms. Garcia, Ms. Finley, and the supervising officer, Sergeant Brian Tunque, as well as the County of Orange and associated entities (entity defendants) under 42 U.S.C. § 1983 (2006), alleging that Mr. Gordon's right to adequate medical care was violated under the due process clause of the Fourteenth Amendment. Ms. Gordon alleged that systematic use of the wrong intake assessment form (i.e., CIWA instead of COWS) resulted in detainees being misclassified and incorrectly housed. She also alleged that jail staff systematically failed to conduct welfare checks from a location allowing visual observation of inmates to ensure safety.
The district court granted summary judgment in favor of the individual defendants, concluding that a due process challenge regarding inadequate medical care required a showing of subjective deliberate indifference, for which there was inadequate evidence. Ms. Gordon appealed.
Ruling and Reasoning
The court ruled that claims for violations of the right to adequate medical care for pretrial detainees made under the Fourteenth Amendment should be evaluated under an objective deliberate indifference standard, not a subjective deliberate indifference standard. Because the district court applied a subjective standard, the granting of summary judgment to individual plaintiffs was in error. Therefore, the summary judgment was vacated and the case remanded.
In Estelle v. Gamble, 429 U.S. 97 (1976), the U.S. Supreme Court held that deliberate indifference by prison officials to serious medical needs of prisoners violated the Eighth Amendment's Cruel and Unusual Punishment Clause. The Ninth Circuit Court of Appeals held in Carnell v. Grimm, 74 F.3d 977 (9th Cir. 1996) that, even though the claims of pretrial detainees arise under the Due Process Clause of the Fourteenth Amendment, the Eighth Amendment provides a minimum standard of care for determining medical care and other rights as a pretrial detainee. As a result, the Ninth Circuit previously analyzed all conditions of confinement claims (including those related to medical care) under a subjective deliberate indifference standard, whether they arose from a convicted prisoner under the Eight Amendment or a pretrial detainee under the Fourteenth Amendment.
Subsequently, in Kingsley v. Hendrickson, 135 S. Ct. 2466 (2015), the U.S. Supreme Court held that a pretrial detainee alleging excessive force must prove that the force used by officers was excessive according to an objective standard, rather than a subjective standard.
Drawing on the U.S. Supreme Court's decision in Kingsley, the Ninth Circuit extended the objective indifference standard to failure-to-protect claims in Castro v. County of Los Angeles, 833 F.3d 1060 (9th Cir.2016). This decision recognized that there is not a single deliberate indifference standard that applies to all 42 U.S.C. § 1983 claims.
In the case at hand, the Ninth Circuit found no logical reason not to extend Castro's objective indifference standard to medical claims because 42 U.S.C. § 1983 contains no state-of-mind requirement independent of what is necessary to state a violation of the underlying federal right. The Ninth Circuit noted that Kingsley was broadly worded such that its holding was not limited to force but applied to the “challenged governmental action” generally. Furthermore, the U.S. Supreme Court had a history of treating “medical care claims substantially the same as other conditions of confinement violations” (Gordon, p 1124). Similarly, the Ninth Circuit had long analyzed claims of failure to address pretrial detainees' medical needs under the same standard as alleged failure-to-protect cases for pretrial detainees. Therefore, a medical care claim against an individual defendant brought under the Due Process Clause of the Fourteenth Amendment must be evaluated under an objective deliberate indifference standard.
The requisite elements of the claim are as follows: First, the defendant made an intentional decision regarding the conditions in which the plaintiff was confined. Second, those conditions put the plaintiff at substantial risk of serious harm. Third, the defendant did not take reasonable measures that were available to address that risk, even though a reasonable individual in said circumstances would have appreciated the high level of risk involved. This conduct must be objectively unreasonable. Finally, due to not taking such measures, the defendant caused the plaintiff's injuries.
Discussion
In general, a prison official can only be found liable under the Eighth Amendment for denying a prisoner humane conditions of confinement if the official knew of and disregarded (i.e., was subjectively aware of) an excessive risk to the prisoner's health and safety. In contrast, the Ninth Circuit's ruling in Gordon v. County of Orange allows a case to proceed under 42 U.S.C. §1983 for failure to provide adequate medical care under the Fourteenth Amendment Due Process clause upon showing that “a reasonable official in the circumstances would have appreciated the high degree of risk” (Gordon, p13), (i.e., the conduct was objectively unreasonable). Under Gordon, the claimant must “prove more than negligence but less than subjective intent—something akin to reckless disregard” (Gordon, p 1125). The Gordon ruling may make it easier for pretrial detainees to succeed on 42 U.S.C. § 1983 claims of failure to provide adequate medical care because they will not have the burden of proving the subjective state of mind of the defendant.
The ruling in Gordon relied heavily on the U.S. Supreme Court decision in Kingsley. It is worth noting that the dissenting opinion in Kingsley, written by Justice Scalia, raised concern that the majority opinion served to “tortify” the Fourteenth Amendment. He referenced the immense body of state and statutory law under which abused individuals can seek relief, rather than via a constitutional claim. In terms of implications for psychiatry, considering this ruling under the lens of Scalia's Kingsley dissent raises concern for increased frequency of successful 42 U.S.C. § 1983 claims against correctional psychiatrists for failure to provide adequate medical care.
Footnotes
Disclosures of financial or other potential conflicts of interest: None.
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