In Sandoval v. County of Los Angeles, published January 13, 2021, a divided panel of the 9th Circuit Court of Appeal reversed summary judgment granted to the defendant county and three jail nurses in a lawsuit brought under 42 U.S.C. section 1983. The plaintiff’s decedent overdosed on methamphetamine before arrest, swallowing the drug in an effort to avoid discovery. The decedent appeared ill when taken into custody. He said he might be diabetic. A nurse tested the decedent’s blood sugar level, which was normal. A deputy told the first defendant nurse that the decedent was ill and needed to be checked more thoroughly. The nurse gave the decedent a second, quick blood sugar test, which was normal, and then left. The decedent was put in a cell that was sometimes used as a medical observation cell and sometimes as a normal holding cell. Although the cell was 20 feet from the nursing station, the first defendant nurse did not check on the decedent for the remaining six hours of the nurse’s shift. The failure may have stemmed from the cell’s mixed use. After the decedent was left unmonitored for eight hours, a deputy noticed the decedent displaying seizure-like behavior. The second defendant nurse, the lead nurse on the response team, was told several times to call paramedics, but refused to do so. The third defendant nurse called the head nurse, who said to call paramedics. She later admitted she should have called paramedics. Instead, EMTs were summoned. EMTs, unlike paramedics, do not have the training to deal with an unresponsive patient and will not transport unresponsive patients. The EMTs advised the nurses that they would not transport the decedent. Paramedics were then summoned. As they tried to transport him, the decedent died. The district court granted summary judgment to all defendants. It sustained several one-sentence objections the defendant made to evidence.
The panel majority held that the district court erred both in sustaining the objections and in granting summary judgment. The majority held that the district court should not have sustained the one-sentence objections, which excluded much evidence important to the plaintiff, particularly relevance and hearsay objections. The court held that relevance objections are seldom useful in summary judgment motions, because the determination of whether a fact is material decides whether it is relevant. It also held hearsay objections are seldom proper, because the focus is on whether the information in the evidence would be admissible at trial, not the form in which it is presented. Turning to the merits, the majority held that the district court erred in determining that because at the time of the incident the standard of liability for a Fourteenth Amendment deliberate indifference claim for medical care to a pre-conviction prisoner incorporated a subjective element, the nurses were entitled to qualified immunity unless they were subjectively aware that their actions violated clearly-established law. Instead, the court held that the qualified immunity prong of whether the nurses violated the constitution would be decided under the current, objective standard; and that the clearly-established-law prong of qualified immunity would also be determined objectively, by deciding whether a reasonable employee, charged with knowledge of the then-existing law, would have believed that his or her conduct was unlawful. Under that standard, summary judgment for the nurses was not appropriate. Viewing the evidence in the light most favorable to the plaintiff, the first defendant nurse acted objectively unreasonably in failing to examine the decedent more thoroughly, and in failing to monitor the decedent for hours. The other two nurses acted objectively unreasonably in failing to summon paramedics, since an objective nurse in their situation would have known that EMTs could not transport an unresponsive patient. All three nurses’ conduct violated the clearly established law that a patient in distress could not be denied immediate medical care. The plaintiff had also submitted sufficient evidence that the county could be held liable for maintaining the policy of using the cell for either medical observation or ordinary holding, creating a situation where the nurses expected deputies to monitor the cell and deputies expected nurses to do so.
A judge concurred that the nurses who failed to summon paramedics were not entitled to qualified immunity, but opined that the first nurse was entitled to qualified immunity. The judge asserted that because the legal standard at the time of the incident required subjective knowledge, there was insufficient evidence the nurse was subjectively aware of the decedent’s medical needs to overcome qualified immunity. The judge further believed that the plaintiff had failed to raise a triable fact on the county’s liability.
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