In Alexander v. Nguyen, published August 25, 2023, the 9th Circuit affirmed a district court's grant of summary judgment in a 42 U.S.C. section 1983 case. The plaintiff was a pretrial detainee who was being treated at a state mental hospital until he was competent to stand trial on a criminal charge. While he was there, a fellow patient struck his head with a fist. The staff considered multiple factors, and determined that the plaintiff should not be moved out of the unit. Instead, they took other measures in an attempt to prevent a further attack. Less than two weeks later, the patient attacked the plaintiff again. The staff then decided to transfer the plaintiff to another unit. There was no further violence toward the plaintiff while he was at the hospital. The plaintiff sued the psychiatrist in charge of his unit, alleging a violation of his 14th Amendment right to substantive due process. The psychiatrist moved for summary judgment, arguing that he had not violated the plaintiff's rights, and that he was entitled to qualified immunity. He supported the motion with an expert affidavit that the psychiatrist had acted within the standard of care. The plaintiff did not offer any evidence disputing the affidavit. The district court granted the psychiatrist summary judgment on the second prong of qualified immunity: That it was not clearly established that his actions violated the Constitution.
The 9th Circuit affirmed on a different ground, the first prong of qualified immunity: That the plaintiff could not establish denial of appropriate medical care in violation of the 14th Amendment. Pretrial detainees' 14th Amendment claims for violation of the right to adequate medical care are determined under an objective deliberate indifference standard. Under that standard, mere lack of due care is not enough to show a constitutional violation. The plaintiff must prove someting more than negligence but less than subjective itnent--something akin to reckless disregard. Similarly, a patient involuntarily committed to a state hospital alleging a violation of the constitutional right to safe conditions, decisions made by appropriate professionals are presumptively valid, and liability may be imposed only when the decision by the professional is such a substantial departure from accepted professional judgment, practice, or standards as to demonstrate that the person responsible actually did not base the decision on such a judgment. Liability requires a finding of conscious indifference amounting to gross negligence. Here, there is no evidence that the psychiatrist failed to act reasonably in response to the first attack on the plaintiff. The benefit of hindsight from the fact that the plaintiff was attacked a second time does not show the psychiatrist's original decision was unreasonable. There was therefore no violation of the plaintiff's constitutional rights.
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