Civil Detainees' Rights to In-Custody Care

Facts of the Case

The unrelated Plaintiffs Michelet Charles and Carol Small are lawful, permanent U.S. residents who had serious mental illness. Both were arrested by the Immigration and Customs Enforcement Agency (ICE) and held as civil immigration detainees in a detention facility in Orange County, New York.

Mr. Charles, a 55-year-old man, was arrested in July 2014 and detained for about a year. He had schizoaffective disorder and a history of hallucinations, delusions, and mood instability when not taking his medications. He was seen by a psychiatrist at Orange County's Detention Facility once every three weeks. His health care insurance expired while he was in custody and could not be renewed.

On July 22, 2015, Mr. Charles was brought to New York City for an immigration court proceeding. The court ordered that Mr. Charles be released from custody. Mr. Charles was released directly from the court with only his identification. The detention center provided him with no records about his treatment while confined, no list or supply of his current medications, no list of outside referrals, nor any plan for care after release. When Mr. Charles returned to the detention facility to obtain his medications, he was told he could not be given medications after release. The ICE deportation officer did not respond to inquiries from Mr. Charles's immigration attorney. Without access to his psychotropic medication and counseling, Mr. Charles quickly decompensated, showing signs of disorganization, paranoia, and mania. On August 4, 2015, his family called 911 and he was admitted to an inpatient psychiatric unit. He was discharged after two months.

Ms. Small, a 45-year-old woman, was detained in May 2015. A month later she began experiencing hallucinations and delusions, and was diagnosed with schizophrenia. In September she was transferred to a community inpatient psychiatric unit. A month later she returned to the detention facility and continued treatment with daily psychotropic medication. On January 11, 2016, an immigration judge ordered Ms. Small's release. On January 19, 2016, she was released from the detention facility in the evening with $80 cash. She was not given a list or supply of her medications, nor did she receive a list of outside referrals. Ms. Small moved to a shelter with the help of a social worker unaffiliated with the detention facility. On January 21, 2016, she used a list of medications she had herself written to obtain psychotropic medications from an emergency room.

On July 12, 2016, Mr. Charles and Ms. Small filed a complaint declaring a violation of their Fourteenth Amendment rights by the defendants (Orange County, Orange County Sherriff's Department, Orange County Department of Mental Health, and the Department of Mental Health's clinical directors). The plaintiffs claimed that “substantive due process requires that civil detainees be afforded adequate medical care during their detention” (Charles, p 80), that discharge planning is an essential part of mental health care, and that failure to provide discharge planning amounts to deliberate indifference to the risk of serious health consequences. The defendants argued that there is no established substantive due process right to the postrelease measures inherent in discharge plans. They argued that “the government's duty of care ends the instant the inmate walks through the prison gates and into the civilian world, because that is when the inmate's ability to secure medication or care on his own behalf is restored” (Charles, p 80).

In September 2017, the District Court for the Southern District of New York granted the defendants' motions to dismiss the case. The district court recognized that correctional facilities are required under the Fourteenth Amendment to provide medical care to civil detainees. Moreover, the court found that the defendants did not provide Mr. Charles and Ms. Small with necessary medical treatment after they were released. The Fourteenth Amendment, however, does not apply to postcustody medical care, and so the district court ruled that the plaintiffs failed to state a claim upon which relief can be granted.

Ruling and Reasoning

The plaintiffs argued that the district court applied an incorrect legal standard because the “deprivation of care” occurred during detention. The Second Circuit agreed with the plaintiffs, stating that although discharge planning is fundamentally different from other types of care because its purpose is to prevent postrelease harm, it is an essential part of mental health care and must occur prior to release. The court referenced policies from the American Psychiatric Association (APA) and The National Commission on Correctional Health Care (NCCHC) in stating that discharge planning should occur before an inmate's release.

The Second Circuit relied upon Estelle v. Gamble, 429 U.S. 97 (1976), in which the Supreme Court held prisoners must be provided medical care to protect their Eighth Amendment rights. These protections were extended to persons without a formal adjudication of guilt, such as civil detainees, under Youngberg v. Romeo, 457 U.S. 307 (1982) and City of Revere v. Mass. Gen. Hosp., 463 U.S. 239 (1983) under the Fourteenth Amendment. The circuit court reasoned that the plaintiffs were deprived of medical care and a Fourteenth Amendment claim could be made if they had a serious medical need for discharge planning and the defendants acted with deliberate indifference to those needs.

To determine whether the plaintiffs had “sufficiently serious needs” to require discharge planning, the Second Circuit considered whether a reasonable doctor or patient would have found their illness worthy of treatment, citing the APA assertion that “timely and effective discharge planning is essential to continuity of care and an integral part of adequate mental health treatment” (Charles, p 88). The court identified Mr. Charles's two-month hospitalization and Ms. Small's extreme emotional and psychological distress as indications of the seriousness of their illnesses.

In considering the claim of deliberate indifference, the court said that the plaintiffs must show that the detention facility “recklessly failed to act with reasonable care to mitigate the risk that the condition posed to the pretrial detainee even though the defendant-official knew, or should have known, that the condition posed an excessive risk to the plaintiff's health or safety” (Charles, p 87, quoting Darnell v. Pineiro, 849 F.3d 17 (2d Cir. 2017), p 35 (emphasis in original)). The court again referred to the APA and NCCHC to determine that the defendant clinic directors, as mental health professionals, should have known about the need for discharge planning. In addition, the court cited written policies by both ICE and Orange County which suggest that the jail should have known the plaintiffs needed discharge planning. For these reasons, the Second Circuit Court vacated the district court's opinion and remanded for proceedings consistent with the opinion. The Second Circuit ruled, therefore, that if proven true by the finder of fact, the allegations are sufficient to establish deliberate indifference to the plaintiffs' medical needs.