In Gordon v. County of Orange, published July 26, 2021, the 9th Circuit Court of Appeals affirmed in part and reversed in part summary judgment in favor of the defendant county and jail employees in a 42 U.S.C. section 1983 case. The decedent f was arrested on heroin-related charges. During his intake at the county jail, the decedent informed the defendant nurse at intake of his heroin habit. Two detoxification protocols existed for assessing inmates suffering from substance withdrawal: one for alcohol (CIWA) and one for opiates (COWS). Jail staff used the CIWA protocol, rather than COWS. A defense expert opined that CIWA was appropriate for a poly-drug abuser. An expert for the plaintiff opined that if COWS had been used, the decedent would have been housed in the medical observation unit instead of general population, and would have been monitored more closely. After his intake, the decedent was not assessed as he waited nearly ten hours to enter the general population. When he entered general population, no CIWA or other evaluation of decedent occurred that day. Although state regulations required hourly safety checks through direct visual observation, and the sheriff's department had a policy that the checks be conducted with a clear, direct view of the inmate, a defendant deputy conducted two of the safety checks from 12-15 feet away, too far away to ascertain whether decedent was breathing or alive. A few hours after entering his cell, decedent was found unresponsive, his face blue and his skin cold. He was pronounced dead. The case was the subject of an earlier appeal, in which the 9th Circuit ruled that inadequate medical care claims brought by pretrial detainees required a showing of objective deliberate indifference. After remand, the district court allowed additional expert discovery, and granted summary judgment for the individual defendants based on qualified immunity and for the county on the ground that the plaintiff could not establish Monell liability.
The 9th Circuit reversed the finding of qualified immunity for the nurse and observing deputy. Regarding the nurse, the 9th Circuit ruled that in 2013, when the incident occurred, a body of authority clearly established that a pretrial detainee had a constitutional right to have a proper medical screen conducted to ensure the medically appropriate protocol was initiated. She was therefore not entitled to qualified immunity under the second prong of the immunity. The case against her was remanded for a factual analysis of whether, under the first prong of qualified immunity, she violated that clearly-established right. As for the observing deputy, the 9th Circuit concluded that while pretrial detainees have a constitutional right to direct-view safety checks sufficient to determine whether their presentation indicates the need for medical treatment, that right was not clearly established in 2013. The 9th Circuit affirmed the grant of summary judgment to the county, because a single incident is insufficient to establish a custom, policy, or practice sufficient to support Monell liability.