Source: https://casetext.com/case/anglin-v-city-of-aspen-colo-dcolo-2009
Timestamp: 2019-04-19 12:43:18+00:00

Document:
Anglin v. City of Aspen, Colo.
David Arthur Lane, Elisabeth Hunt White, Killmer, Lane Newman, LLP, Denver, CO, for Plaintiff.
Andrew Joseph Fisher, Marni L. Nathan Kloster, Nathan, Bremer, Dumm Myers, PC, Eric Michael Ziporin, Senter Goldfarb Rice, LLC, Denver, CO, Melanie Bailey Lewis, Josh Adam Marks, Berg Hill Greenleaf Ruscitti, LLP, Boulder, CO, for Defendants.
EDWARD W. NOTTINGHAM, Chief Judge.
This is a civil rights case in which Plaintiff Brownyn Anglin alleges Defendants violated her rights to due process and free speech, as well as her right to be free from unreasonable seizure, by forcibly injecting her with antipsychotic medication while she was in custody at the Pitkin County Jail. This matter is before the court on "Medical Defendants' Joint Motion for Summary Judgment and Brief in Support," filed April 11, 2007. Three other summary judgment motions are currently pending before the court in this case. The instant motion is brought solely by Defendant Chris Martinez, M.D., who authorized Plaintiff's forcible injection. Jurisdiction is premised upon the existence of a federal question pursuant to 28 U.S.C. §§ 1331 and 1343.
Plaintiff fails to deny this assertion by Dr. Martinez, an assertion which find support in the record. ( See Pl.'s Med. Resp., RSOF ¶ 15, Ex. 10 ¶ 7 [Martinez Decl.].) Thus, I deem Dr. Martinez's allegation admitted.
Plaintiff admits that Dr. Martinez made this statement. ( See Pl.'s Med. Resp., RSOF ¶ 16.) Plaintiff does not deny the truth of the statement. ( Id.) Moreover, she provides no record evidence supporting a finding that Paramedic Coniglio failed to actually relay this information to Dr. Martinez. ( Id.) Thus, I deem Dr. Martinez's allegation admitted.
Plaintiff admits that Dr. Martinez made these statements. ( See Pl.'s Med. Resp., RSOF ¶ 17.) Plaintiff does not deny that Dr. Martinez in fact learned this information from the Paramedics. ( Id.) Thus, I deem Dr. Martinez's allegation admitted.
Plaintiff admits that Dr. Martinez and Paramedic Coniglio made these statements and others in this paragraph. ( See Pl.'s Med. Resp., RSOF ¶ 20.) Plaintiff does not explicitly deny the truth of the statement. ( Id.) Further, Plaintiff provides no record evidence supporting a finding that the Paramedics failed to observe Plaintiff after injecting her. ( Id.) Thus, I deem Dr. Martinez's allegation admitted.
In this particular instance that we're talking about, I wanted an appropriate dose for [Plaintiff] that would quickly and efficiently take care of the problem — take care of the potential problems as I perceived them in her case.
And since she was resisting evaluation and resisting our attempts to adequately examine her, it seemed most reasonable not to try to do repeat attempts of medication if they were necessary. Instead, the most prudent choice at that particular time was to give the amount of medication in one dose that should adequately take care of the problem and at the same time be most beneficial for her condition.
Plaintiff does not deny this allegation or any other allegation in paragraph four of Dr. Martinez's Statement of Facts. ( See Pl.'s Med. Resp., RSOF ¶ 4.) The allegations in paragraph four are directly supported by Dr. Martinez's declaration. ( See Med. Defs.' Br., Ex. B ¶¶ 1-2.). Absent a denial, I deem these allegations admitted.
On August 11, 2006, Plaintiff filed a complaint in this court alleging the following constitutional violations stemming from her involuntary sedation: (1) denial of due process by all Defendants in violation of the Fourteenth Amendment; (2) unreasonable seizure by all Defendants in violation of the Fourth Amendment; (3) constitutional failure to train by Defendants Police Chief Loren Ryerson, Sheriff Braudis, Aspen Valley Hospital, and Dr. Martinez; and (4) retaliation for Plaintiff's exercise of free speech in violation of the First Amendment by Officer Davis, Officer Calvano, and Deputy Geister. (Compl. and Jury Demand [filed Aug. 11, 2006].) On April 11, 2007, Medical Defendants filed a motion for summary judgment on all counts against them. (Med. Defs.' Br.) On June 14, 2007, Plaintiff responded to the motion. (Pl.'s Med. Resp.) On July 2, 2007, Dr. Martinez filed a reply in support of the motion. (Martinez's Reply.) This matter is fully briefed and ripe for review.
Pursuant to Rule 56(c) of the Federal Rules of Civil Procedure, the court may grant summary judgment where "the pleadings, the discovery and disclosure materials on file, and any affidavits show that there is no genuine issue as to any material fact and that the movant is entitled to judgment as a matter of law." Fed.R.Civ.P. 56(c) (2008); see Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248-50 (1986); Concrete Works, Inc. v. City County of Denver, 36 F.3d 1513, 1517 (10th Cir. 1994). The moving party bears the initial burden of showing an absence of evidence to support the nonmoving party's case. Celotex Corp. v. Catrett, 477 U.S. 317, 325 (1986). "Once the moving party meets this burden, the burden shifts to the nonmoving party to demonstrate a genuine issue for trial on a material matter." Concrete Works, 36 F.3d at 1518 (citing Celotex, 477 U.S. at 325). The nonmoving party may not rest solely on the allegations in the pleadings, but must instead designate "specific facts showing that there is a genuine issue for trial." Celotex, 477 U.S. at 324; see Fed.R.Civ.P. 56(e)(2) (2008). A fact in dispute is "material" if it might affect the outcome of the suit under the governing law; the dispute is "genuine" if the evidence is such that it might lead a reasonable jury to return a verdict for the nonmoving party. Allen v. Muskogee, 119 F.3d 837, 839 (10th Cir. 1997) (citing Anderson, 477 U.S. at 248). The court may consider only admissible evidence when ruling on a summary judgment motion. See World of Sleep, Inc. v. La-Z-Boy Chair Co., 756 F.2d 1467, 1474 (10th Cir. 1985). The factual record and reasonable inferences therefrom are viewed in the light most favorable to the party opposing summary judgment. Byers v. City of Albuquerque, 150 F.3d 1271, 1274 (10th Cir. 1998) (citing Concrete Works, 36 F.3d at 1517).
Dr. Martinez contends he is entitled to summary judgment on all of Plaintiff's claims against him because: (1) he is not a state actor; (2) his actions did not constitute a violation of Plaintiff's Fourth or Fourteenth Amendment rights; and (3) his training and supervision of the Paramedics was not constitutionally deficient. ( See Med. Defs.' Br.) After briefly reviewing the law of 42 U.S.C. § 1983 ("Section 1983"), I consider each of Dr. Martinez's arguments in turn.
[e]very person who, under color of any statute, ordinance, regulation, custom, or usage, of any State . . . subjects, or causes to be subjected, any citizen of the United States or other person within the jurisdiction thereof to the deprivation of any rights, privileges, or immunities secured by the Constitution and laws, shall be liable to the party injured in an action at law, suit in equity, or other proper proceeding for redress.
Id. Thus, to establish a violation of Section 1983, Plaintiff must allege that: (1) Defendants acted under color of state law to deprive her of a right, and (2) the right of which Defendants deprived her was secured by the Constitution or the laws of the United States. See Am. Mfrs. Mut. Ins. Co. v. Sullivan, 526 U.S. 40, 49-50 (1999). With these general considerations in mind, I address Dr. Martinez's arguments in further detail below.
"The traditional definition of acting under color of state law requires that the defendant in a [Section] 1983 action have exercised power possessed by virtue of state law and made possible only because the wrongdoer is clothed with the authority of state law." West v. Atkins, 487 U.S. 42, 49 (1988) (internal quotation marks omitted). Under such circumstances, it can be said that the defendant's alleged constitutional violation is "fairly attributable to the state." Id. (quotation marks omitted).
Determining whether particular conduct constitutes state action "frequently admits of no easy answer." Jackson v. Metro. Edison Co., 419 U.S. 345, 350 (1974). Courts are to take a "flexible approach to the state action doctrine, applying a variety of tests to the facts of each case." Gallagher v. Neil Young Freedom Concert, 49 F.3d 1442, 1448 (10th Cir. 1995). The Tenth Circuit has recognized the applicability of four tests for determining whether state action exists. Id. First, the close nexus test asks "`whether there is a sufficiently close nexus between the State and the challenged action of the regulated entity so that the action of the latter may be fairly treated as that of the State itself.'" Id. (quoting Jackson, 419 U.S. at 351). Second, the symbiotic relationship test finds state action when "the [S]tate has `so far insinuated itself into a position of interdependence' with the private party." Id. (quoting Burton v. Wilmington Parking Auth., 365 U.S. 715, 725.) Third, under the joint action test, the court will find state action if "a private party is a `willful participant in joint activity with the State or its Agents.'" Id. (quoting Adickes v. S.H. Kress Co., 398 U.S. 787, 764 [further internal quotation marks omitted]). Finally, the public functions test finds state action when "a private entity . . . exercises `powers traditionally exclusively reserved to the State.'" Id. (quoting Jackson, 419 U.S. at 352).
The fact that the State employed respondent[-physician] pursuant to a contractual arrangement that did not generate the same benefits or obligations applicable to other `state employees' does not alter the analysis. It is the physician's function within the state system, not the precise terms of his employment, that determines whether his actions can fairly be attributed to the State. Whether a physician is on the state payroll or is paid by contract, the dispositive issue concerns the relationship among the State, the physician, and the prisoner. Contracting out prison medical care does not relieve the State of its constitutional duty to provide adequate medical treatment to those in its custody, and it does not deprive the State's prisoners of the means to vindicate their Eighth Amendment rights. The State bore an affirmative obligation to provide adequate medical care to [plaintiff-inmate]; the State delegated that function to respondent[-physician]; and respondent[-physician] voluntarily assumed that obligation by contract.
Id. at 55-56. The Court noted that a contrary holding would mean "`the state will be free to contract out all services which it is constitutionally obligated to provide and leave its citizens with no means for vindications of those rights, whose protection has been delegated to private actors, when they have been denied.'" Id. at 56 n. 14 (quoting West v. Atkins, 815 F.2d 993, 998 [4th Cir. 1987]).
Dr. Martinez proffers the district court case of Sykes v. McPhillips, 412 F. Supp. 2d 197 (N.D.N.Y. 2006), as "particularly instructive." (Med. Defs.' Br. at 17.) In Sykes, the plaintiff filed suit under Section 1983 against the defendant-physician, alleging constitutional violations arising from the delivery of emergency medical services at a private hospital to the plaintiff's incarcerated decedent. 412 F. Supp. 2d 197. Although the hospital had no contract with the State, it had on several occasions provided the state detention facility with a letter stating that it would treat inmates presented for care. Id. at 199. The defendant-physician was the only emergency room physician attending patients at the time the inmate was presented for care, and he worked at the hospital as an independent contractor. Id. The plaintiff-inmate argued that the defendant-physician should be deemed a state actor because his medical group contracted to provide emergency services to the hospital, and he should have known that the hospital regularly treated inmates. Id. at 203. The court found no state action when "a physician engaged in a single encounter with a prisoner presented for emergency treatment, which he was obligated under law to provide," and which occurred outside of the prison context. Id. at 204. While acknowledging that "it is probable that state actor status may be conferred through less than express contracting," the court found no state action. Id. Dr. Martinez argues this, and other district court cases suggesting the focus of the state action inquiry is on the relationship between the physician and the State, bar a finding of state action in the instant case. ( See Med. Defs.' Br. at 16-17; Martinez's Reply at 7-11.) Although none of the cases identified by the parties is wholly on point, I find much of Conner's reasoning persuasive, as I discuss in more detail below.
Regardless of whether the private physician has a contractual duty or simply treats a prisoner without a formal arrangement with the prison, the physician's function within the state system is the same: the [S]tate authorizes the physician to provide medical care to the prisoner, and the prisoner has no choice but to accept the treatment offered by the physician. Even where a physician does not have a contractual relationship with the [S]tate, the physician can treat a prisoner only with the [S]tate's authorization. . . . The source of deprivation does not change because the physician has no contractual relationship with the [S]tate: the physician acts under color of state law because the state has incarcerated the prisoner and denied him the possibility of obtaining adequate medical care on his own.
42 F.3d at 225. Even the Sykes court admits that "it is probable that state actor status may be conferred through less than express contracting." 412 F. Supp. 2d at 202. Thus that Dr. Martinez did not contracted directly with the State to treat inmates does not bar a finding that when he treated Plaintiff, he was acting under color of state law.
If [physician-defendant] misused his power by demonstrating deliberate indifference to [plaintiff-inmate's] serious medical needs, the resultant deprivation was caused, in the sense relevant for state-action inquiry, by the State's exercise of its right to punish [plaintiff-inmate] by incarceration and to deny him a venue independent of the State to obtain needed medical care.
Id. at 55. Thus, determining whether Dr. Martinez is a state actor is not a mono-factored analysis of the relationship between the doctor and the State. Instead, under the caselaw cited by both parties, the state action question requires a multi-factored, flexible analysis, tailored to the specific facts of the case at hand. See Gallagher, 49 F.3d at 1447 ("The Court has taken a flexible approach to the state action doctrine, applying a variety of tests to the facts of each case."). In West, for instance, the court found state action based on the relationship between the prisoner and the State, the physician's voluntary assumption of an obligation to provide medical care to inmates by contract, and the fact that the care at issue was provided in an institutional setting. See 487 U.S. at 55-57. The Conner court found that the inmate's inability to choose his own medical provider, considered along with the physician's voluntary assumption of care of a prisoner upon referral by the state, sufficient to constitute state action. 42 F.3d at 226. In finding no state action, the Sykes court considered the facts that the physician provided care to the inmate in the context of a private hospital, had not contracted with the State to provide care to inmates, and gave care he was required to give by law to the prisoner in question only one time and on an emergency basis. 412 F. Supp. 2d at 203-04. Thus, this court must proceed to a fact-specific analysis of the present case.
At the outset, I find that when Dr. Martinez ordered Plaintiff be sedated, he undertook a public function, because "the provision of medical services to prison inmates is traditionally the exclusive prerogative of the [S]tate." Conner, 42 F.3d at 224; West, 487 U.S. at 55-56; see also Gallagher, 49 F.3d at 1447. As in West, and virtually all inmate healthcare cases, in choosing to detain Plaintiff, the State "den[ied her] a venue independent of the State to obtain . . . medical care." Id. at 55. In authorizing Dr. Martinez to provide healthcare to Plaintiff, a detainee of the State, the State delegated its constitutional duty to provide adequate medical treatment to those in its custody. See West, 487 U.S. at 56. Under West, the State cannot, by choosing to delegate its constitutional duties to the professional judgment of others, thereby avoid all liability flowing from the attempted fulfillment of those duties under Section 1983. Id. at 56 n. 14. The State's absolute control over a detainee's access to medical care, coupled with the State's constitutional responsibility to provide adequate necessary medical care to detainees weighs in favor of finding state action when the State authorizes a physician to provide medical care to a detainee. Id. at 55-56. As the Conner court noted, regardless of the contractual relationship between the physician and the State, "the [S]tate authorizes the physician to provide medical care to the prisoner, and the prisoner has no choice but to accept the treatment offered by the physician." 42 F.3d at 225. This lack of choice on the part of the detainee rings particularly true in the instant case, where Plaintiff attempted to refuse the medical care provided. Thus, the relationship between Plaintiff and the State ways in favor of a finding of state action.
Another factor that weighs in favor of finding state action is the fact that the medical care at issue was provided to Plaintiff in an institutional setting, which "inevitably affects the exercise of professional judgment." West, 487 U.S. at 57; Sykes, 412 F. Supp. 2d at 201-202 (noting that "it is clear" that medical staff providing care inside a prison facility are state actors). For instance, the Paramedics could not, in attempting to calm Plaintiff without an injection, consider removing her from confinement, direct that she be allowed to personally check on her daughter, or demand that she be released, even if they perceived that such actions would have forestalled any need to chemically sedate Plaintiff. Moreover, Dr. Martinez had to consider those means of restraint available in the jail, rather than those means of restraint that may have been available at the hospital. ( See Med. Defs.' Br., Ex. B ¶ 9 [Martinez Dec.] [noting Dr. Martinez considered the fact that the jail's restraint chair was occupied in deciding to sedate her chemically].) Based on the foregoing, it is likely that "the nonmedical functions of prison life . . . influence[d] the nature, timing, and form of medical care provided to" Plaintiff. West, 487 U.S. at 57. Thus, that Plaintiff's medical care was provided in a jail, rather than a hospital, militates in favor of a finding of state action.
Dr. Martinez, however, contends that because he was legally obligated to provide emergency medical care to any patient presented to him, including inmates, any treatment relationship with Plaintiff was essentially involuntary, and thus could not serve as a basis to find him a state actor. (Martinez's Reply at 12-13.) I recognize that several courts, including the West and Conner courts, have considered whether the relationship between the physician and the inmate was voluntary in deciding whether the physician's medical care was provided under color of state law. See West, 487 U.S. at 56 (noting that physician-respondent-physician "voluntarily assumed" the obligation to provide medical services to inmates); Conner, 42 F.3d at 226 (finding that when the State "delegates" the duty to provide medical care to inmates "to a physician who voluntarily assumes that obligation, that physician acts under color of state law"). In the instant case, Dr. Martinez has presented evidence that he was obligated by law to treat Plaintiff once contacted by the Paramedics. ( See Martinez's Reply at 12-13 [citing 42 U.S.C. § 1395dd].) This court is not convinced, however, that the law requiring Dr. Martinez to provide medical care to individuals presented for emergency treatment mandates a finding that his provision of medical services to Plaintiff was involuntary. After all, Dr. Martinez was admittedly a "subcontractor" for the emergency room of a state hospital. (Pl.'s Med. Resp., RSAF ¶ 19; admitted at Martinez's Reply at 4.) In that capacity, he was assured to come into contact with inmates from time to time. For the purposes of this motion, however, I find Dr. Martinez's treating relationship with Plaintiff was involuntary, which militates against a finding of state action.
This undisputed testimony supports a finding that sedations at Pitkin County Jail often occur under the authorization and supervision of an Aspen Valley Hospital emergency room doctor, such as Dr. Martinez. Moreover, Dr. Martinez has made clear that AEM contracted to provide emergency medicine physicians (meaning more than one), to the Emergency Department at Aspen Valley Hospital. (Med. Defs.' Br., SOF ¶ 4; admitted at Pl.'s Med. Resp., RSOF ¶ 4.) Thus, this court may reasonably infer that Pitkin County Jail emergency sedations have a reasonable chance of being authorized by a physician whose relationship with the State is akin to that of Dr. Martinez. If I were to find Dr. Martinez was not a state actor here, Pitkin County Jail's policy of delegating many decisions to sedate detainees and inmates to Aspen Valley Hospital's Emergency Room, which is staffed at least in part by AEM physicians, would effectively serve to insulate the State from any liability for constitutional harms flowing from these sedations. This is exactly the kind of result the Supreme Court sought to avoid in West. 487 U.S. at 56 n. 14. Accordingly, under the narrow facts of this case, I find that Dr. Martinez's decision to involuntarily sedate Plaintiff while in the confines of Pitkin County Jail was "fairly attributable to the state" and, thus, under color of state law. Id. at 49 (quotation marks omitted). Thus, I proceed to Dr. Martinez's arguments regarding Plaintiff's Fourth and Fourteenth Amendment claims against him.
It is well-established that "the forcible injection of medication into a nonconsenting person's body represents a substantial interference with that person's liberty," thus, triggering the protections of the Due Process Clause. Washington v. Harper, 494 U.S. 210, 229 (1990). In Harper, the Supreme Court found that "forcing antipsychotic drugs on a convicted prisoner is impermissible absent a finding of overriding justification and a determination of medical appropriateness." Riggins v. Nevada, 504 U.S. 127, 135 (1992) (citing Harper, 494 U.S. at 229). In Riggins, the Court found that "[t]he Fourteenth Amendment affords at least as much protection to persons the State detains for trial." Id. In reaffirming this precept, the Court found that the injection of antipsychotic drugs compromises a person's liberty in a "particularly severe" way. Id. at 134. The Court in Harper and Riggins did not have before it, and did not address, what process might be required before state prison authorities may administer an antipsychotic drug in an emergency circumstance, as opposed to regularly in the course of ongoing, long-term treatment. See Harper, 494 U.S. at 246-47 (Stevens, J. dissenting). Since the Supreme Court's decision in Harper, neither the Supreme Court nor the Tenth Circuit has addressed what due process is required to sedate a detainee in emergency circumstances.
Prior to Harper, however, the Tenth Circuit had already addressed this issue to some degree in Bee v. Greaves, 744 F.2d 1387 (10th Cir. 1984). In Bee, the court explicitly held that "a pretrial detainee retains a liberty interest derived from the Constitution in avoiding unwanted medication with [antipsychotic] drugs." 744 F.2d at 1394. The court based its holding, in part, upon the "undisputed nature of antipsychotic drugs," which "have the capacity to severely and even permanently affect an individual's ability to think and communicate." Id. at 1393-94. Nonetheless, the court found that, even absent a hearing, forced antipsychotic medication on a pretrial detainee may be appropriate when the State makes a showing that "treatment with [such] medication was medically appropriate and, considering less intrusive alternatives, essential for the sake of [the detainee's] own safety or the safety of others." Id. at 1395.
Based on the foregoing authority, Plaintiff clearly retains a protected liberty interest in avoiding unwanted medication. This conclusion does not end the court's inquiry. Plaintiff's liberty interest "must be balanced against competing state interests to determine whether it is outweighed by `the demands of an organized society.'" Id. at 1394 (quoting Youngberg v. Romeo, 457 U.S. 307, 320, 102 S.Ct. 2452, 73 L.Ed.2d 28). The only competing state interest the Tenth Circuit has explicitly recognized that may be sufficient to overcome a pre-trial detainee's liberty interest in avoiding unwanted antipsychotic medication without a hearing is an emergency that threatens the safety and security of jail occupants. Id. at 1395-96. The court was careful to note, however, that "[a]bsent an emergency, . . . [it] did not believe forcible medication with antipsychotic drugs is reasonably related to the concededly legitimate goals of jail safety and security." Id. at 1395 (internal quotations and citation omitted).
Determining that an emergency exists sufficient to warrant involuntary medication with this type of drug requires a professional judgment-call that includes a balancing of the jail's concerns for the safety of its occupants against a detainee's interest in freedom from unwanted antipsychotics. Any decision to administer antipsychotic drugs forcibly must be the product of professional judgment by appropriate medical authorities, applying accepted medical standards. It requires an evaluation in each case of all the relevant circumstances, including the nature and gravity of the safety threat, the characteristics of the individual involved, and the likely effects of particular drugs.
If, in the context of prolonged treatment [as in Harper], an inmate may be involuntarily medicated with an antipsychotic drug if a medical professional determines such medication to be in the inmate's best medical interests, then a fortiori the [S]tate retains the authority to administer such a drug in an emergency situation based upon the same medical judgment. To the extent that Harper can be read as constitutionally requiring full independent review of a medical judgment before administering an antipsychotic drug, we believe that such a holding would be properly understood as addressed to the circumstance of long-term treatment there at issue, and not as extending to emergencies. Otherwise, the state would be obliged, as the district court would have here required, to convene full-scale adversary proceedings at the any hour of the night, appoint and retain counsel, subpoena witnesses, and allow for cross-examination — all while the very inmates for whose protection the state is constitutionally responsible remain in danger of injury at their own hands.
Id. at 1117. I agree.
Thus, I now turn to the question of whether Dr. Martinez properly assessed the existence of a medical emergency warranting forcible sedation. Bee makes clear that whether an emergency exists sufficient to warrant sedation is a "professional judgment-call" to be undertaken by medical professionals rather than law enforcement officials. See 744 F.2d at 1395-96. To properly find an emergency existed warranting forcible sedation, Dr. Martinez must have exercised reasonable medical judgment in determining that Plaintiff was likely to injure herself or others and that no effective, alternative, less-restrictive means of restraint were available. See id. at 744 F.2d at 1393-96.
As an initial matter, I note that under the Federal Rules of Evidence, Plaintiff's lay opinion testimony regarding Dr. Martinez's medical judgment as well as the import of the FDA warning would almost certainly be inadmissible. See Fed.R.Evid. 701 (2008) (Lay opinion testimony is limited to "those opinions or inferences which are (a) rationally based on the perception of the witness, and (b) helpful to a clear understanding of the witness' testimony or the determination of a fact in issue, and (c) not based on scientific, technical, or other specialized knowledge within the scope of Rule 702.); see also World of Sleep, 756 F.2d at 1474 (noting that the court may consider only admissible evidence when ruling on a summary judgment motion). Additionally, considering that the decision of whether or not a medical emergency exists warranting sedation of an inmate is indisputably a medical judgment to be made by medical professionals, Bee, 744 F.2d at 1395-96, and in light of the medical opinions supporting Dr. Martinez's medical judgment that an emergency existed because Plaintiff was a danger to herself and that the medicine and dosage chosen by Dr. Martinez was appropriate ( see Med. Defs.' Br., Ex. D at 7-10 [Expert Disclosure I], Ex. E at 4-9 [Expert Disclosure II]), I find Plaintiff's lay opinion to the contrary and Plaintiff's proffered FDA warning are insufficient to create a disputed issue of fact regarding Dr. Martinez's professional judgment-call. See Brown v. United States, 74 F. App'x 611, 613-14 (7th Cir. 2003) (finding that in determining whether administration of analgesics was based on reasonable medical judgment, "[t]he knowledge of a medical expert far outmatches that of a common layman"); see also Buckman Co. v. Plaintiffs' Legal Comm., 531 U.S. 341, 350 (2001) (noting that courts, several States, and the FDA recognize the value and propriety of off-label use).
Nonetheless, Plaintiff contends that Dr. Martinez relied on incorrect — or at least disputed — facts in making the medical decision to sedate Plaintiff. (Pl.'s Med. Resp. at 30.) For instance, according to Plaintiff, Dr. Martinez relied on false reports that Plaintiff was banging her head and her body — rather than simply her fists and feet — against her cell door. ( Id.) Plaintiff, however, has presented no evidence that Dr. Martinez himself misrepresented facts upon which he relied in deciding to sedate Plaintiff, nor has Plaintiff presented evidence that Dr. Martinez had any reason to disbelieve the facts as presented to him by the Paramedics. ( See Pl.'s Med. Resp. at 26-37.) Thus, Plaintiff has presented no evidence to suggest that, based on the facts before him, Dr. Martinez's medical judgment was flawed.
Finally, Plaintiff argues that Dr. Martinez failed to adequately consider alternative, less-restrictive means of restraint. ( See id. at 34-35.) Here, there is undisputed evidence that Dr. Martinez considered that the jail's sole restraint chair was in use by a violent male during the night in question. ( See id., Ex. 11 ¶ 9 [Martinez Decl.].) Still, Plaintiff argues that the doctor failed to consider whether Plaintiff should have been placed in the jail's isolation cell. ( Id. at 36.) I would find any such oversight harmless, because Plaintiff does not dispute that the jail's sole isolation cell was in use during the night in question. ( See Pl.'s Med. Resp.; see also id., Ex. 2 at 3-4 [Geister Dep.].) Thus, any error in failing to ask about the cell could not have ultimately had a causal affect on Dr. Martinez's decision to sedate Plaintiff. Joseph v. Shepherd, 211 F. App'x 692, 703 (10th Cir. 2006) (noting that Section 1983 requires a plaintiff to show that defendant's actions caused a constitutional violation). Based on the foregoing, I find Plaintiff has failed to establish a genuine issue of material fact as to whether Dr. Martinez's medical judgment that an emergency existed warranting sedation was proper given the information before him. Thus, I grant summary judgment in favor of Dr. Martinez on Plaintiff's Fourteenth Amendment claim.
Dr. Martinez contends that restraint and injection of a detainee in the context of an emergency does not constitute a "seizure" cognizable under the Fourth Amendment. (Med. Defs.' Br. at 18-19.) Plaintiff contends that because there is a disputed issue of fact as to whether sufficient evidence existed to allow Dr. Martinez to conclude Plaintiff was a danger to herself, the forcible restraint and injection of Plaintiff was an unreasonable seizure. ( See Pl.'s Med. Resp. at 37-42.) Plaintiff does not argue that the Paramedics, under Dr. Martinez's direction, used more force than necessary to effectuate the injection. ( Id.) Without deciding whether forcible restraint and injection of antipsychotic medication is a seizure for Fourth Amendment purposes, I find that because Plaintiff has failed to demonstrate a disputed issue of material fact regarding Dr. Martinez's medical judgment that Plaintiff was likely to injure herself, her unreasonable seizure argument necessarily fails. ( See Analysis § 2b, supra.) Thus, I grant summary judgment in favor of Dr. Martinez on Plaintiff's Fourth Amendment claim.
Finally, Dr. Martinez argues summary judgment is warranted on Plaintiff's constitutional failure to train claim against him. ( See Med. Defs.' Br. at 31-33.) Plaintiff counters that the doctor's failure to train his paramedics on the constitutional parameters of forced injections is actionable. ( See Pl.'s Med. Resp. at 42-44.) To succeed on a failure to train claim under Section 1983, Plaintiff must put forth evidence showing that "the failure to train amounts to a deliberate indifference to the rights of persons with whom [the paramedics] come into contact." City of Canton v. Harris, 489 U.S. 378, 388-89 (1989). In the instant case, undisputed evidence supports a finding that the Paramedics were trained in a protocol which required paramedics, when they encounter a patient whom they perceive to have an altered mental status, to contact the emergency medical physician on duty at the hospital to determine if there was a need to consider chemical restraint. ( See Med. Defs.' Br., Ex. B-2 at 8-9 [Protocols]; see id., SOF ¶¶ 9-12; admitted in relevant part at Pl.'s Med. Resp., RSOF ¶¶ 9-12.) Thus, the protocol required that the emergency room physician, rather than the paramedics, decide whether chemical restraint was appropriate. ( See Med. Defs.' Br., Ex. B-2 at 8-9 [Protocols].) In the instant case, all evidence supports a finding that Dr. Martinez, rather than the Paramedics, made an independent medical judgment as to whether or not to sedate Plaintiff. (Pl.'s Med. Resp., Ex. 10 ¶ 10 [Martinez Decl.], Ex. 9 ¶¶ 8-9 [Coniglio Decl.].) Plaintiff has simply failed to explain how a protocol that directed paramedics to call an emergency room physician to determine whether or not to sedate an inmate in any way shows a deliberate indifference to that inmate's constitutional rights. To the contrary, such a protocol comports with the Tenth Circuit's holding in Bee that "[a]ny decision to administer antipsychotic drugs forcibly must be the product of professional judgment by appropriate medical authorities." Bee, 744 F.2d at 1395-96 (internal citations omitted). Accordingly, I grant summary judgment in favor of Dr. Martinez on Plaintiff's failure to train claim.
Based on the foregoing it is therefore ORDERED that the Medical Defendants motion for summary judgment is GRANTED with respect to Dr. Martinez.

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