Government Liability Update

Paramedics Did Not Owe Duty to Perform Adequate Medical Examination of Person Who Refused Treatment

In Murphy v. City of Petaluma, published November 25, 2024, the First District Court of Appeal, Division 1 affirmed summary judgment in favor of the defendant city and two of its paramedics.  The plaintiff was involved in a head-on collision.  The defendant paramedics responded to the scene.  They asked the plaintiff questions to determine her involvement in the collision and whether she was hurt or needed medical assistance.  She stated she was not hurt and did not want or need medical assistance.   The paramedics did not observe any signs of injury, any signs the plaintiff was in pain, or any signs of cognitive impairment. One of the paramedics explained to the plaintiff that it was possible she had suffered an injury of which she was unaware, that the injury could manifest later, and that the injury could be life-threatening.  He recommended that she accept transportation to a hospital where she could be examined as a precautionary measure.  The plaintiff responded she was aware of the risks, but again declined transportation to the hospital.  The paramedic advised the plaintiff of the potential signs of serious injury of which she should be aware.  After attending to the other driver, the paramedic returned to the plaintiff to ask if she had developed a headache or required medical assistance.  She again refused medical assistance, and still did not display objective signs of injury or cognitive impairment.  Before the paramedics left, one of the paramedics again obtained confirmation from the plaintiff that she did not want or need medical assistance.  Based on their observation of the plaintiff, the paramedics concluded she was alert and oriented, had capacity, and had expressly exercised her right to refuse medical treatment.  After leaving the scene, the plaintiff suffered a stroke in her sleep, due to a hypertensive crisis caused by the collision.  The plaintiff sued the city and paramedics, alleging the paramedics were grossly negligent in their medical examination, evaluation, and treatment of her, including failing to take her blood pressure and failing to transport her to a medical facility.  The trial court granted the defendants' motion for summary judgment, concluding that no medical care was initiated and that the paramedics did not take any action that created a duty to perform a full assessment of the plaintiff's medical condition.

The appellate court agreed.  The plaintiff contended the paramedics owed her a duty of care to provide medical assistance in accordance with Health and Safety Code section 1799.106 under the negligent undertaking doctrine.  Emergency rescue personnel, like other persons, have no general duty to protect others from the conduct of third parties.  The negligent undertaking rule is an exception.  Where one undertakes to aid another, the person is under a duty to exercise due care in acting, and is liable if the failure to do so increases the risk of harm or if the harm is suffered because the other relied on the undertaking.  The plaintiff contended that by virtue of the paramedics interactions with her at the scene they assumed a duty to provide her with adequate medical care.  She maintained her refusal to of medical care was irrelevant to the duty issue.  She did not claim that the paramedics were negligent in their assessment that she had the cognitive capacity to exercise her right to refuse medical assistance.  The court rejected the plaintiff's argument. As with other first responders, the scope of the duty the paramedics assumed must be measured by the particular level of service they provided.  That level of service was dictated by the plaintiff's repeated refusal of medical assistance and transport.  After she made these statements, the paramedics did not undertake a medical examination.  Therefore, they did not assume a duty to conduct such an examination meeting the applicable standard of care.  Further, there is no evidence that the paramedics' conduct increased the harm or risk of harm inflicted by the third party.  The paramedics left the plaintiff in exactly the position she occupied before they arrived.  They therefore did not have a duty to render medical assistance to the plaintiff in accordance with the standard of care.

Police Officers Entitled to Qualified Immunity for Following Paramedic's Advice in Restraining Suspect; Paramedic Entitled to Qualified Immunity Due to Unclear Law

In Perez v. City of Fresno, published April 15, 2024, a divided panel of the 9th Circuit Court of Appeals affirmed summary judgment for the defendant city, police officers, and paramedic.  The sheriff’s office received a call of a man acting erratically, including sprinting through the street.  City officers encountered the plaintiffs’ decedent before deputies could respond. The defendant officers encountered the plaintiffs’ decedent acting erratically, and determined he was under the influence of a controlled substance.  According to the officers, to prevent him from darting into traffic or charging the officers, they seated him on the curb and placed him in handcuffs.  The dispatched deputies found the suspect in handcuffs and surrounded by city officers.  A city officer called emergency medical services to facilitate an involuntary psychiatric detention of the suspect.  While awaiting an ambulance, the decedent stood up and refused to comply with officers’ instructions.  Several officers took the suspect to the ground to prevent him from running into traffic.  The suspect’s face repeatedly hit the ground. An officer lifted the suspect’s head off the ground with a towel, while another confirmed the suspect could breathe.  While the suspect was lying on his stomach, he kicked.  The officers restrained the suspect’s legs, then removed the restraint 30-60 seconds later when the ambulance arrived.  The EMS paramedics brought out a backboard.  The officers removed the towel and assisted the paramedics in applying the backboard.  The suspect yelled he could not breathe.  A defendant paramedic nevertheless told one of the officers to sit on the backboard.  The officer sat on the backboard for 90 seconds while other officers applied pressure.  After the seated officer stood up, the paramedics continued securing the suspect to the backboard then turned him over.  Once the suspect was on his back, the paramedics discovered he did not have a pulse.  The suspect passed away.  The coroner attributed the death to compression asphyxia during restraint with methamphetamine toxicity as a significant contributor.  The suspect’s family sued the officers and paramedic under 42 U.S.C. section 1983 for violations of the 4th and 14th Amendments, and the city and county for Monell liability based on failure to train.  The district court granted the defendants summary judgment, finding the individuals entitled to qualified immunity, and finding insufficient evidence of deliberate indifference in training.

The panel ruled that the officer defendants were entitled to qualified immunity.  The only use of force the plaintiffs challenged was that taking place after the paramedics arrived, including the paramedics’ determination that the suspect needed to be placed on a backboard to facilitate transport to the hospital, and the paramedic instructing the officers to assist in securing the suspect to the backboard by sitting on him while he was prone.  The officers testified that they defer to medical personnel that respond to an emergency scene on medically-related matters.  Existing case law holding that pressing down an erratically-behaving suspect who protests he cannot breathe does not address officers acting at the direction of medical personnel.  Existing law did not clearly establish the officers were required to second guess the paramedics on medical care.  The majority also rejected the argument that the officers’ constitutional violation was obvious.  It was not obvious that applying the backboard in this manner, as directed by a medical professional trained to respond in emergency situations, would violate the Constitution. The court also rejected the argument that the officers were not entitled to qualified immunity because they departed from their training.  Case law does not establish that any violation of police policy or guidance is, in and of itself, sufficient to deny qualified immunity.  Official training and guidance can influence the qualified-immunity analysis, but they are not determinative.  Even if the officers contravened their training, that would not defeat qualified immunity in this case.  The paramedic was also entitled to qualified immunity.  The law did not clearly establish at the time that a paramedic a paramedic restraining a person to secure the person for medical transport could be held liable for a constitutional violation under either the 4th or 14th Amendment.  There is no Supreme Court or 9th Circuit precedent establishing constitutional liability under similar circumstances.  Authority from other circuits looks to whether paramedics are acting in a law-enforcement capacity (which can give rise to a section 1983 claim) or a medical capacity (which is analyzed for medical malpractice).  There was no evidence from which a reasonable jury could conclude that the paramedic was acting in a law-enforcement capacity during his interaction with the suspect.  The evidence was that the suspect was being restrained so that he could be transported for treatment, not so that he could be arrested or punished.  Due to the lack of precedent imposing constitutional tort liability on a paramedic in this situation, the paramedic is entitled to qualified immunity.  Finally, absent a pattern of excessive-force incidents by untrained officers that resulted in the outcome here, the plaintiffs could not establish Monell liability for failure to train.  Further, there was evidence the agencies at issue maintained policies to prevent restraint and positional asphyxia.  While two officers testified they were not trained on prone-restraint asphyxia, the possible inadequate training of two officers is insufficient to support a Monell claim.

One judge concurred in the grant of qualified immunity to the paramedic, and to the affirmance of summary judgment on Monell liability, but disagreed that the officers were entitled to qualified immunity.  The judge opined that federal case law, departmental guidance, and common sense gave officers fair warning that applying continuous force to the back of a prone person who claims he cannot breathe is constitutionally excessive.

Interagency Firefighting Immunity Does Not Apply to Non-Fire Lifesaving Activities

In Wilson v. County of San Joaquin, published July 30, 2019, the Third District Court of Appeal reversed summary judgment in favor of the defendant county.  The plaintiffs' infant child, in critical condition, was transported from plaintiffs' house by private ambulance.  Two City of Stockton firefighters rode in the ambulance and performed emergency medical procedures.  The infant eventually passed away. The city firefighters provided their services under an agreement between the city and county under which the city's fire department would provide emergency medical services as part of the county's emergency medical services system.  The plaintiffs sued the county for the firefighters' lifesaving efforts.  They alleged that the firefighters committed medical malpractice and professional negligence.  The trial court granted the county summary adjudication under Government Code section 850.6.  Section 850.6 provides that when a public entity provides "fire protection or firefighting service" outside of the public entity's regular area, the public entity receiving the fire protection or firefighting service is not liable for any act or omission of the public entity providing the service.

The appellate court concluded that section 850.6's immunity did not apply.  The Law Revision Commission comment on section 850.6 stated that the statute makes clear which public entity is liable "when one entity calls for the assistance of another in fighting a fire."  The comment, along with the statute's plain language, indicates that it applies only to services related to fighting a fire.  Cases interpret a related immunity, Government Code section 850.4 (providing immunity for injury caused in fighting fires) not to apply absolute immunity to lifesaving actions unrelated to fighting fires; instead, Health & Safety Code section 1799.107 provides only a qualified immunity to such activities, immunizing public entities and emergency rescue personnel from liability for providing emergency medical services unless performed in bad faith or in a grossly negligent matter.  The court concluded the placement of both section 850.4 and 850.6 in the same chapter suggests a legislative intent that they be interpreted similarly.

Firefighting Immunity Applies to Accident in Which Sleeping Firefighter Run Over by Shower Servicing Truck

In Quigley v. Garden Valley Fire Protection District, published April 19, 2017, the Third District Court of Appeal affirmed nonsuit in favor of the defendant district in a personal injury lawsuit brought by a firefighter.  During the Silver Fire, the United States Forest Service set up a base camp at Plumas County Fairgrounds.  It set up a shower unit in the infield of the fairgrounds' racetrack, and arranged for an independent contractor to service the unit.  A nonfirefighting team, which became employees of the defendant district, managed the base camp.  The plaintiff, a Forest Service firefighter, obtained permission to sleep in the infield during a break from fighting the fire.  The infield was not roped off or signed as a sleeping area.  While she was sleeping, a truck servicing the shower unit ran over the plaintiff, seriously injuring her.  She sued the district and the management team for failure to warn, negligence, and dangerous condition of public property.  The trial court granted nonsuit based on (among other grounds) Government Code section 850.4's firefighting immunity.

The appellate court agreed with the trial court that the defendants did not waive the section 850.4 immunity, even though they did not plead it.  Governmental immunity is jurisdictional and can be raised at any time.  The court disagreed with the holding in McMahan’s of Santa Monica v. City of Santa Monica (1983) 146 Cal.App.3d 683 that section 850.4 immunities, unlike other immunities, must be pleaded or else waived.  Absolute immunities such as section 850.4, unlike qualified immunities that depend on specific facts being true, cannot be waived.  The court further rejected the argument that the immunity applied only when firefighting facilities are being used for firefighting.  The statute's wording and legislative history establish that it alternatively applies to firefighting facilities and equipment, even when not being used to fight fires.