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.