Qualified immunity

Pena v. Givens, No. 14-11020, 2015 WL 7434253 (5th Cir. Nov. 23, 2015)

State psychiatric ER employees are entitled to qualified immunity against claim by the estate of a man who died in the ER

Background: After arriving at a fire station and complaining that he was being chased, George Cornell was taken by police to the Parkland psychiatric emergency room (the “Psych ER”). Cornell resisted when technicians tried multiple times to take his vitals, and tried to leave the Psych ER. Cornell was taken into a seclusion room, held on a mat on the floor, and given a mixture of Haldol, Ativan, and Benadryl to calm him. When Cornell became agitated again and ripped up a floor tile, the technicians attempted to move him to a new room, but he resisted and they administered another injection of the same three medications. Cornell was held on his stomach for some amount of time (possibly up to 15 minutes) following the second injection before the technicians left the room. A nurse found him lying prone in the room, and Cornell was transferred to the main emergency room, where he died. Following Cornell’s death, the medical examiner found the cause of death to be undetermined but listed three potential causes: (1) mechanical compression; (2) underlying cardiac issues; or (3) effects of the medication he received in the Psych ER. Cornell’s representatives sued technicians, doctors, nurses, and hospital supervisors alleging excessive force, physical restraint, denial of adequate medical care, staff supervision violations. The United States District Court for the Northern District of Texas denied defendants’ motions for summary judgment on grounds of qualified immunity, and the defendants brought an interlocutory appeal.

Holding: On interlocutory appeal, the Fifth Circuit held per curiam that the technicians, nurse, doctor, and supervisors were all entitled to qualified immunity. The Court noted a lack of binding authority holding that “a medical professional’s restraint of an individual in an emergency medical situation constitutes a Fourth Amendment seizure.” Further, the Court noted that “even police officers’ use of restraint does not implicate the Fourth Amendment if they are acting in an emergency-medical-response capacity” (emphasis in original). Important to the Fifth Circuit on both the excessive force and substantive due process claims was the fact that Cornell resisted the Parkland staff. Regarding the substantive due process violation due to physical restraint, the Fifth Circuit noted that the staff’s conduct violated hospital policy but did not amount to conduct that “shocks the conscience.” 

Regarding the denial of adequate medical care, the Fifth Circuit noted the “recognized…special relationship for incarcerated and involuntarily committed individuals,” which requires a state to protect the citizen from harm.2 Plaintiffs must demonstrate that state official acted with “deliberate indifference.” Thus, the defendants must have been “on notice” of Cornell’s heart condition and then consciously refused to provide further care. Here, the Fifth Circuit pointed out that “Cornell resisted the officers when they tried to provide care,” and posited that they could not say “that a reasonable jury could conclude that the failure to treat a heart condition after a patient refuses care and begins attacking staff amounts to deliberate indifference.” Finally, regarding the lack of supervision claim, the Fifth Circuit noted that the subordinates’ actions had not been found to be a constitutional violation, therefore the supervisors could not be held liable for constitutional violations.

Notable Points:

Restraint while rendering emergency medical aid: Even though the training given to technicians warned not to hold patients in a prone position for extended periods of time, the Fifth Circuit cited Sheehan in saying that “if an officer acts contrary to her training…that does not itself negate qualified immunity where it would otherwise be warranted.”

Found in Found in DMHL Volume 34, Issue 4