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Crowson v. Washington County State of Utah.

Nos. 19-4118 & 19-4120.  D.Utah. Judge McHugh. 42 USC § 1983—Fourteenth Amendment—Eighth Amendment—Interlocutory Appeals—Qualified Immunity—Pendant Appellate Jurisdiction.

December 28, 2020

Plaintiff was an inmate at the Washington County Jail. He suffered physical symptoms that a nurse and a doctor diagnosed as drug or alcohol withdrawal symptoms. Plaintiff’s condition deteriorated, and after seven days, he was transported to the hospital, where he was properly diagnosed with toxic metabolic encephalopathy. After plaintiff recovered, he brought claims against the nurse, the doctor, and Washington County (County) under 42 USC § 1983, alleging various violations of the Eighth and Fourteenth Amendments.

The individual defendants filed motions for summary judgment on the basis of qualified immunity, and the County also filed a motion for summary judgment. The district court denied all three motions, concluding that (1) a reasonable jury could find that both individual defendants were deliberately indifferent to plaintiff’s serious medical needs, and it was clearly established that their conduct amounted to a constitutional violation; and (2) the treatment failures were an obvious consequence of the County’s reliance on the doctor’s infrequent jail visits and its lack of written protocols for monitoring, diagnosing, and treating inmates.

On appeal, the individual defendants challenged the district court’s denial of qualified immunity. Qualified immunity shields officials from civil liability where their conduct does not violate clearly established statutory or constitutional rights that a reasonable person would have known. The Fourteenth Amendment prohibits deliberate indifference to a pretrial detainee’s serious medical needs. Under the Eighth Amendment, a pretrial detainee must show a sufficiently serious deprivation and that the prison official knew of and disregarded an excessive risk to inmate health or safety. The Tenth Circuit assumed, without deciding, that the harm plaintiff suffered met the objective component (serious deprivation) of the Eighth Amendment inquiry. As to the nurse, his role was to serve as a gatekeeper for other medical personnel. While he misdiagnosed the symptoms as withdrawal-related and could have done more for plaintiff, he contacted the doctor and notified the appropriate authorities, and thus was not deliberately indifferent to his gatekeeper role. The nurse was therefore entitled to qualified immunity.

As to the doctor, the Tenth Circuit assumed without deciding that he was deliberately indifferent in not personally examining plaintiff or obtaining a blood test, and it analyzed whether it was clearly established that reaching a diagnosis without blood test results violated plaintiff’s rights where his symptoms were consistent with either withdrawal or encephalopathy. The doctor’s diagnosis in the absence of blood test results fell between two lines of precedent. Because the conduct fell in a gray area, the Tenth Circuit concluded that not every reasonable official would have known it was a violation of plaintiff’s constitutional rights to proceed with a diagnosis in the absence of blood test results. The doctor was therefore entitled to qualified immunity.

The County contended that the Tenth Circuit should exercise pendant appellate jurisdiction to review the district court’s denial of its summary judgment motion. The Tenth Circuit had discretion to exercise pendant appellate jurisdiction over the County’s appeal to the extent the issues raised were inextricably intertwined with the district court’s denial of qualified immunity. Plaintiff’s claim against the County for failure to train its nurses was inextricably intertwined because of the determination that the nurse did not violate plaintiff’s constitutional rights. Summary judgment should therefore have been granted as to that claim. The claim for reliance on policies and procedures that were deliberately indifferent to prisoners’ medical needs was not inextricably intertwined, because the Tenth Circuit did not decide whether the doctor violated plaintiff’s constitutional rights, instead concluding that the right was not clearly established.

The district court’s denials of summary judgment to the nurse and doctor were reversed, the district court’s denial of summary judgment to the County on the failure to train theory was reversed, and the County’s appeal for lack of appellate jurisdiction as to the systemic failure theory was dismissed for lack of jurisdiction.

Official US Court of Appeals for the Tenth Circuit proceedings can be found at the US Court of Appeals for the Tenth Circuit website.

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