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.