Government Liability Update

County Immune from Liability to Hospital under Knox-Keene Act

In County of Santa Clara v. Superior Court (Doctors Medical Center of Modesto), published April 26, 2022, the Sixth District Court of Appeal issued a writ directing a trial court to sustain the petitioner county's demurrer to the real party hospitals' complaint.  The county operates a health care plan licensed under the Knox-Keene Health Care Service Plan Act, Health & Safety Code section 1340 et seq.  The hospitals provided emergency services to members of the county's healthcare plan.  The hospitals submitted claims to the county for over $144,000, the amount the hospital alleges is the reasonable value of the services provided.  The county reimbursed the hospital approximately $28,500.  The hospitals sued the county for reimbursement.  It asserted tort and implied-in-law causes of action.  The trial court sustained the demurrer without leave to amend as to the tort causes of action, and granted leave to amend the breach of implied contract cause of action.  In the operative complaint, the hospital asserted a single cause of action alleging implied-in-fact and implied-in-law contracts with the county.  The trial court overruled the demurrer to the complaint, ruling that the hospitals stated facts sufficient to constitute a cause of action for quantum meruit or implied-in-fact contract.

The appellate court ruled that the trial court erred.  The implied-in-law contract/quantum meruit claim is barred by Government Code section 815, which immunizes public entities from liability on common law theories.  Case law establishes that section 815 bars quantum meruit actions against public entities.  The appellate court rejected the hospitals' argument that the Knox-Keene Act imposed a mandatory duty upon the county that gave rise to a cause of action under Government Code section 815.6.  Section 815.6's application requires that the enactment be obligatory, requiring that a particular action be taken or not taken; and that if the public entity or officer is under an obligation to function, that the function itself not involve the exercise of discretion.  While Health & Safety Code section 1371.4(b) imposes a duty on the county to reimburse the hospitals, the statute calls for reimbursement of the "reasonable and customary value" of the services performed.  The statute therefore gives the county discretion in the amount of reimbursement to pay.  The section therefore does not create a purely mandatory duty, and does not authorize the hospitals' implied-in-law contract cause of action.  No other statute authorizes the hospitals' action for damages.  The complaint also alleges an implied-in-fact contract.  Because Government Code section 815 does not affect liability based on contract, it does not preclude an action for breach of an implied-in-fact contract.  But the single cause of action is ultimately based on alleged breach of a noncontractual duty--the county's alleged obligation under county ordinances and the Knox-Keene Act to pay for the care and treatment the hospitals rendered.  Because the suit is based on alleged breach of statutory duty rather than alleged breach of promise, its nature is tortious and the county is immune from suit under section 815.  Because the hospitals failed to show how they could amend the complaint to save the action, they were not entitled to leave to amend.

 

 

Jail Medical Personnel Not Entitled to Qualified Immunity for Allegedly Providing Inadequate Care to Inmate Displaying Serious Cardiac Symptoms

In Russell v. Lumitap, published April 13, 2022, the 9th Circuit Court of Appeals affirmed in part and reversed in part an order denying summary judgment to medical providers at a county jail.  The decedent prisoner came to prison medical providers complaining of vomiting, chest pain, and anxiety.  The first nurse who saw him gave him Pepto-Bismol and referred him for a mental health screening.  The second nurse, who saw him at the mental health intake center, gave him a dose of nitroglycerin.  The decedent’s pain increased.  The nurse called the on-call doctor, who ordered the decedent be given Motrin and be screened for mental illness.  The doctor never examined the decedent in person.  The decedent received a mental health screening and was returned to jail.  The inmate then returned to the jail medical clinic complaining of more severe pain.  She knew that per policy, if nitroglycerin did not relieve the patient’s symptoms, the patient should be hospitalized.  She called the nurse at the mental health intake center, who told her of the doctor’s orders.  The nurse administered Motrin and the decedent remained for observation.  The patient consulted with another nurse, who instructed him on relaxation and gave him a heat balm.  Eventually, the nurse observed the decedent in extreme distress.  She called paramedics.  The decedent was transferred to a hospital where he died.  He had suffered an aortic dissection.  The decedent’s parents sued the various medical personnel under 42 U.S.C. section 1983, alleging deliberate indifference.  The defendants moved for summary judgment based on qualified immunity.  The district court denied the motion, finding genuine issues of material fact.

The 9th Circuit affirmed as to all but one nurse.  At the time of the decedent’s death, a deliberate-indifference claim under the 14th Amendment were decided on the same standard as 8th Amendment claims, requiring a showing of deliberate indifference.  Later, the Supreme Court held that a plaintiff alleging a 14th Amendment violation need not show subjective deliberate indifference; only that the force used was objectively unreasonable.  The 9th Circuit then applied this rule to 14th Amendment claims, requiring that the plaintiff show that the defendant made an intentional decision putting the plaintiff at substantial risk of serious harm, and then did not take reasonableavailable measures to abate that risk, even though a reasonable official in the circumstances would have appreciated the high degree of risk involved—making the consequences of the defendant’s conduct obvious.  The court applies this objective standard to determine whether the defendants violated clearly-established law, even where the incident occurred before the change in the law.  The standard can be met where the care rendered is so inadequate to the circumstances known to the medical staff as to amount to deliberate indifference.  At the time of decedent’s death, the 9th Circuit had found deliberate indifference where nurses and a doctor had prescribed palliative treatment in response to serious symptoms, or providing life-saving measures to an inmate in obvious need.  Further, other circuits had applied the standard to obvious symptoms of heart attack, such as those the decedent displayed here.  Under this standard, a jury could find that all of the medical personnel—except for the nurse who called the doctor, and followed his orders (entitling her to qualified immunity)—violated clearly established law by having access to information that the decedent had a substantial risk of serious injury, and providing constitutionally inadequate treatment.

Farm States 1st Amendment Retaliation Claim against School District for Discontinuing Field Trips Based on Social Media Posts

In Riley’s American Heritage Farms v. Elsasser, published March 17, 2022, the 9th Circuit Court of Appeals reversed in part and affirmed in part summary judgment granted to public school defendants in a 42 U.S.C. section 1983 case seeking damages and injunctive relief.  Over a 16-year  period, schools within the defendant school district booked field trips with the plaintiff farm.  One of the principal shareholders made controversial statements on his personal social media account.  In response, some parents complained about their students traveling on field trips to the farm, and a local newspaper published an article about the incident.  The school district severed its relationship with the farm.  The farm sued the district, individual board members, and administrators, alleging 1st Amendment retaliation.  The district court granted the defendants summary judgment.

 

The 9th Circuit held that the farm had set forth a prima facie claim for first amendment retaliation.  Because the farm stood in the same position as an independent contractor to the government, the Pickering test for First Amendment retaliation applied.  There was no issue that the farm had engaged in protected expressive activity; that the defendants took an adverse action against the farm; and that the defendants were motivated to do so by the farm’s expressive conduct.  The burden shifted to the school defendants to show that their interests in preventing disruption to their operations and curricular design were so substantial that they outweighed the plaintiff’s free speech interests.  Viewing the evidence in the light most favorable to the plaintiff, because the speech was outside the scope of school communications, did not mention the school, and resulted in only a small number of complaints and coverage, the defendants did not carry their burden sufficiently to obtain summary judgment.  On the second prong of qualified immunity, the individual defendants were entitled to summary judgment, because the law at the time did not place the question of whether they violated the plaintiff’s 1st Amendment rights beyond debate.  The defendants were not entitled to summary judgment against the injunctive relief claim, because the superintendent’s testimony that there was still a policy against booking field trips to the farm was sufficient to create a genuine issue of fact on whether the plaintiff continued to suffer from an ongoing constitutional violation.

 

Favorable Termination Element of Section 1983 Malicious Prosecution Claim Requires Only That Prosecution Ended without Conviction

In Thompson v. Clark, published April 4, 2022, a divided U.S. Supreme Court reversed a judgment in favor of police officer defendants on a 4th amendment malicious prosecution claim.  The plaintiff was accused by a mentally ill relative of sexually abusing his one-week-old daughter.  Four police officers arrived at the plaintiff's apartment.  The plaintiff told the officers they could not enter without a warrant.  The officers entered, and, after a scuffle, handcuffed the plaintiff.  No sign of abuse was found.  The officers arrested the plaintiff for resisting their entry into the apartment.  An officer filed a criminal complaint against him for resisting arrest and obstructing governmental administration.  A judge released him.  Before trial, the court granted the prosecution's motion to dismiss the case.  No explanation was given for the motion to dismiss or the dismissal.  The plaintiff sued the officers under 42 U.S.C. section 1983 for malicious prosecution.  The district court entered judgment for the officers, on the ground that the favorable termination element of malicious prosecution could not be satisfied because the criminal case had not ended in a way that affirmatively indicated the plaintiff's innocence.  The Second Circuit Court of Appeals affirmed.  Because the circuits were split on the favorable termination element, the Supreme Court granted review.

The majority held that a 4th Amendment claim under section 1983 for malicious prosecution does not require the plaintiff to show that the criminal prosecution ended with some affirmative indication of innocence.  The plaintiff need only show that the criminal prosecution ended without conviction.  The plaintiff did so here.  The court reached that conclusion by examining the nature of the malicious prosecution tort in 1871, when section 1983 was passed.  Case law interpreting that tort required for favorable termination only that the prosecution end without conviction.  The interpretation is also consistent with the values and purposes of the 4th Amendment.  The question of whether a criminal defendant was wrongly charged does not logically depend on whether the
prosecutor or court explained why the prosecution was dismissed. The individual’s ability to seek redress for a wrongful prosecution cannot reasonably turn on the fortuity of whether the prosecutor or court happened to explain why the charges were dismissed.  Requiring an affirmative indication of innocence would paradoxically foreclose a section 1983 claim when the government’s case was weaker and dismissed without explanation before trial, but allow a claim when the government’s evidence was substantial
enough to proceed to trial.  Further, officers will be protected from unwarranted civil suits by the requirement the plaintiff show the absence of probable cause, and by qualified immunity.

Three dissenting justices opined that there should be no 4th Amendment malicious prosecution claim.