Officer Denied Qualified Immunity for Failure to Summon Medical Care for Pretrial Detainee
In Horton v. City of Santa Maria, 915 F.3d 592 (9th Cir. 2019), the Ninth Circuit Court of Appeals reviewed the district court's denial of summary judgment to a police officer, reversing the denial on one charge but upholding it on a second charge. Officer Brice was responsible for a pretrial detainee, Shane Horton, at the time Mr. Horton made a suicide attempt. In this case, the first claim was for violation of the due process clause of the Fourteenth Amendment, and the second claim was for failure to provide medical care to Mr. Horton. The Court of Appeals found there was a genuine issue of fact regarding whether Officer Brice acted appropriately.
Facts of the Case
In December 2012, 18-year-old Shane Horton was arrested by Officers Brice and Schneider for misdemeanor vandalism in Santa Maria, California. The circumstances leading to the arrest involved a physical altercation between Mr. Horton and his girlfriend. She drove away with a friend. Mr. Horton slashed the tires of the friend's car. Officer Brice interviewed Mr. Horton's girlfriend at the scene. She disclosed that Mr. Horton had previously hit her several times, chased her with a knife, stabbed a friend in the leg, and made statements about killing police and feeling sympathetic toward perpetrators of recent mass homicides. Officer Schneider placed Mr. Horton in a holding cell, leaving on his belt. Mr. Horton expressed feeling anxious and told him that he had had a difficult three weeks, describing recent drug use, having been assaulted, and his dislike of the jail cell. Officer Schneider stated he would “[p]robably do a psych” and instructed Mr. Horton to wave at the security camera if he needed anything.
About 90 minutes later, Officer Brice visited Mr. Horton, letting him know that his girlfriend was granted a restraining order and that he was being charged with felony domestic violence. Officer Brice asked if he had any medical problems. Mr. Horton stated he did not. Mr. Horton called his mother, who told him she would not bail him out and requested to speak privately to Officer Brice. She disclosed to Officer Brice that her son had been using drugs, extinguished cigarettes on himself, punched his fist through a window, cut his wrist with broken glass, and held a kitchen knife pointed at his throat. Two weeks before, he was held overnight at the emergency room as a suicide risk. The doctors suspected the problem was “mostly drugs” and discharged him in the morning due to his not being suicidal. Ms. Horton told Officer Brice she disagreed with the conclusion that he could be safely discharged. She believed he was depressed and suicidal and that he could be helped in the judicial system.
The phone call lasted 10 to 15 minutes. Officer Brice went to complete paperwork and returned to Mr. Horton's cell after a total of 27 minutes. Mr. Horton was hanging by his belt, which he had affixed to his cell door. Only his lower body was visible on the security camera, so the injury had not been apparent. Officer Brice called for assistance, administered cardiopulmonary resuscitation, and waited for paramedics to arrive. Mr. Horton survived, but suffered prolonged anoxia and severe irreversible brain damage.
With his mother acting as guardian ad litem, Mr. Horton sued Officer Brice, other officers, the City of Santa Maria, and the Santa Maria Police Department. They made claims that his Fourteenth Amendment due process rights under 42 U.S.C. § 1983 (1996) and his state right to medical care while in custody were violated, alleging that Mr. Horton should have received medical care. There was an additional negligence claim that will not be addressed here. The defendants moved for summary judgment on the basis of qualified immunity. The district court denied summary judgment to Officer Brice, the City, and the Police Department on both claims. All other defendants were granted summary judgment.
Ruling and Reasoning
Qualified immunity serves to protect government officials from liability unless their conduct violates a clearly established standard that a reasonable person would have known. The first claim was for violation of 42 U.S.C. § 1983, which states that a person who knowingly causes another person to be deprived of their constitutional rights is liable to the injured party; here, that right was access to medical care. The Court of Appeals pointed out that a reasonable officer would not have known that failing to check on Mr. Horton and summon medical attention immediately would be unconstitutional; therefore, this right was not clearly established. Thus, the district court erred in denying summary judgment to Officer Brice on this charge.
California state law (Cal. Gov't Code § 845.6 (1970)) dictates that a public employee cannot be held liable for failing to provide medical care to a prisoner unless the employee knows or should know that the prisoner requires immediate medical attention. The plaintiff must establish the public employee knew (or should have known) there was an immediate need for medical care and failed to summon that care. The Court of Appeals noted that Mr. Horton clearly required medical attention. Officer Brice knew Mr. Horton was recently suicidal, had been hospitalized, and was displaying erratic behavior. The court noted that, if Officer Brice had requested a prompt psychiatric evaluation, Mr. Horton might have been discovered sooner and might have suffered a briefer period of anoxia. The Court of Appeals indicated these were matters of fact and it could not be determined only as a matter of law whether Officer Brice's shortcomings proximately caused injury to Mr. Horton. The court thus upheld the decision to deny summary judgment to Officer Brice on this charge.
Dissent
On the claim under California Government Code § 845.6, Judge Bybee favored granting summary judgment to Officer Brice. Judge Bybee acknowledged Officer Brice's checking on Mr. Horton sooner might have limited the extent of brain damage; however, Judge Bybee said this would not have prevented the suicide attempt because, when the phone call concluded, Mr. Horton was already hanging. The plaintiff posited immediate medical care was needed as Mr. Horton was at risk of hurting himself but did not specify the type of medical care indicated. By the time Officer Brice found Mr. Horton, he required resuscitation, but this could not have been predicted. A psychiatric evaluation might have been appropriate but would not have prevented his injury. Judge Bybee contended that while Officer Brice's decision not to immediately check on Mr. Horton may not have been prudent, it did not constitute a failure to summon medical care.
Discussion
The court noted that the claim raised important points about the duty of the police department toward detainees, but that it lacked jurisdiction to review the claim against the municipal defendants. The court (both the majority and the dissent) focused their analysis on questions related to liability and immunity from liability. While the case primarily focused on the rights of prisoners to medical care, it is clear that Mr. Horton's suicide attempt occurred in the setting of system-based shortcomings that transcended the role of a single officer. For example, it is not clear whether emergency psychiatric evaluation would have been available if Officer Brice had requested one. While there was a camera monitoring the cell, it did not provide staff with a full view of the cell and Mr. Horton. While the department had a policy of removing jackets, belts, and shoes from detainees, the court found the policy was widely regarded as optional.
This case highlights the important role of psychiatrists in educating jail staff, law enforcement personnel, and the courts about suicide and suicide prevention. In this case, perhaps if officers had had more education about suicide, risk factors for suicide, and strategies to prevent suicide, there would have been more measures in place to mitigate the risk of suicide. In addition, officers might have been more willing to follow policies that reduce suicide risk if they had more training and education on the rationale for the policies. Psychiatrists are subject matter experts who can help jail staff and law enforcement personnel understand these problems and thereby help minimize suicide risk in correctional settings. Psychiatrists also have the training, education, and experience to help courts understand these challenges and to analyze cases when there is an adverse outcome such as in the present case.
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