Opinion ID: 12443
Heading Depth: 2
Heading Rank: 3

Heading: Qualified Immunity Here

Text: 66 We turn now to the final qualified immunity issue: would all reasonable state medical school residency program supervisors, similarly situated to Drs. Smith and Binder and with the information they had, have realized that their conduct was unreasonable under all the circumstances, balancing Dr. Pierce's privacy interests against the interests of TTUHSC, and hence invaded Dr. Pierce's Fourth Amendment rights? On the basis of the undisputed historical facts, we answer this question in the negative. 67 When Dr. Smith, director of the TTUHSC residency program, learned of the February 22 incident at St. Joseph's in Phoenix, he was objectively faced with what could reasonably be considered as a most serious situation. Dr. Pierce, one of the TTUHSC residents in its emergency medicine residency program, while on brief rotation at St. Joseph's, had slapped an emergency room patient in the face. The patient was about to undergo a CAT scan for a possible internal head injury following an automobile accident in which he had smashed through his car's windshield. He was flat on his back on the CAT scan table, was under restraints, and technicians were holding him down. Dr. Pierce stated that after she tightened his restraints he spat in her face, and she then slapped him, not for any therapeutic purpose but in an impulsive reaction of surprise or anger. However, she slapped him at least twice, three times according to the March 2 letter to Dr. Smith from Dr. Shamos, director of the St. Joseph's trauma center. Dr. Pierce described the slaps as hard and fairly hard. After she had hard slapped the patient, Dr. Pierce, who was the only physician present, left the room and washed her face. She returned and approached the patient, whereupon, as she described it, a nursing supervisor came and grabbed me by the arm and physically pulled me away from the patient, saying something like get away from him. Dr. Pierce thereafter remained outside the room, where she was when, some time later, the other physician on duty arrived. 68 The St. Joseph's administration initially wanted to immediately terminate Dr. Pierce, but she was ultimately allowed to participate in the remaining three days of her rotation, provided she underwent counseling, which she did. The counselor recommended that on her return to El Paso she contact the University Psychiatric department to continue counseling sessions. 69 Dr. Pierce, a licensed physician, was in the residency program in order to become a board certified emergency room physician. She admitted the obvious: that she was in the program both to learn and to be taught; that she sought a diploma or certificate from Texas Tech which would in substance attest to her special competence as an emergency room physician; that it was common to have aggressive patients in the ER and not a rare occasion for a hostile or aggressive patient to come in; that her slapping the patient was inappropriate; that the practice of medicine requires that a doctor be able to make calm, rational decisions in life or death situations, and emergency medicine physicians need to be capable of remaining calm and engaging in rational behavior in the heat of emergency situations and able to react calmly and coolly in tough situations; and that it was appropriate for those in charge of the residency program to assess her ability to do those things, as well as to assess whether she had good interpersonal skills, which would be needed in an emergency room setting, and also to investigate the reasons why she engaged in inappropriate behavior. 70 This was not the first time Dr. Pierce had come to the unfavorable attention of the TTUHSC faculty and administration. During the previous summer, a faculty committee had found that her performance was not up to the level of acceptable standards and she had been placed on probation for, among other things, excessive tardiness, failing to carry an acceptable number of patients, and poor interpersonal relationships with faculty and patients. At that time in 1989 some of the faculty discussed drug use as one of the possible explanations for Dr. Pierce's behavior. Dr. Nelson had even questioned her about drug use, receiving a negative response. 17 Although her probation had ended before her St. Joseph's rotation--and the St. Joseph's personnel were unaware of it--some of Dr. Pierce's same problems continued. Dr. Shamos's written evaluation of her at St. Joseph's ranked her in the very lowest category in each of the areas of Patient Relationships and Professional Relationships. 71 Dr. Smith, as a result of learning of the February 22 incident, placed Dr. Pierce on probation, with pay, pending investigation. It was determined to have Dr. Pierce undergo a psychiatric evaluation and, in connection with it, a drug urine test. When Dr. Pierce was informed of this, she objected to the drug analysis. Dr. Smith told her he would take it up with the faculty, and she was ultimately told by Dr. Smith she would be dismissed if she refused to be tested. 18 However, Dr. Pierce did not commit herself and no action was taken. On March 23--some nine days after first being notified of the drug test scheduled for her by Dr. Robert Smith--Dr. Pierce, without any prior notice to anyone at TTUHSC, was tested in a wholly unobtrusive manner by a private laboratory of her own choosing that furnished the results, which were negative, to her only. After Dr. Smith received this report from Dr. Pierce, and after he also received the psychiatric evaluations of Dr. Pierce by Dr. Robert Smith and Dr. Salo, 19 Dr. Pierce's probation was lifted. 72 Objectively, there was ample, reasonable basis for singling out Dr. Pierce for special scrutiny and investigation of a kind not applicable to others in the residency program. Dr. Pierce, not long after coming off probation, committed serious professional misconduct in her capacity as a member of the residency program. In light of these occurrences, a decision had to be made as to whether, or under what circumstances, TTUHSC would allow her to remain a part of its emergency medicine residency program. Drug test results--like the psychiatric evaluations--were simply to be one part of that decision-making process, not its ultimate focus or sole determinant. Objectively, something caused Dr. Pierce's behavior in the program to be seriously inappropriate. What things associated with her brought this about? Information in this respect could objectively enhance the reliability of the ultimate decision to be made as to the appropriate future for Dr. Pierce in the residency program. 73 As we have observed, drug use among physicians has indeed been a problem (see note 9, supra ). Appellants' expert witness Dr. Briones testified that Dr. Pierce exhibited many of the behavioral problems that are symptomatic of drug use, such as incidents of unprofessional and out-of-character behavior, unexplained absences, and tardiness. See also Michael Fleming, Physician Impairment: Options for Intervention, 50 Am. Fam. Physician 41 (July 1, 1994) (explaining that substance problem indicators include changes in work habits, unusual work schedule, a change in prescribing habits, procedural errors, complaints from staff and patients, and severe medical record tardiness). Drug use, though not objectively shown to be a likely cause in Dr. Pierce's case, could at least be reasonably considered as one possible contributing factor, and it was not objectively unreasonable to want some further information which could either confirm or render less likely that possibility. This approach was not necessarily calculated to be detrimental to Dr. Pierce. She could only benefit from a negative drug test. However, she delayed for several days. 20 74 We recognize that in order to preclude qualified immunity it is not necessary that the very action in question has previously been held unlawful, Anderson at 640, 107 S.Ct. at 3039, or that the plaintiff point to a previous case that differs only trivially from his case. K.H. Through Murphy v. Morgan, 914 F.2d 846, 851 (7th Cir.1990) (emphasis added). However, the facts of the previous case do need to be materially similar. Lassiter v. Alabama A & M University, 28 F.3d 1146, 1150 (11th Cir.1994) (en banc) (emphasis added). We also recognize that the egregiousness and outrageousness of certain conduct may suffice to obviously locate it within the area proscribed by a more general constitutional rule: There has never been a section 1983 case accusing welfare officials of selling foster children into slavery; it does not follow that if such a case arose, the officials would be immune from damages liability ... K.H. Through Murphy at 851. But the same common sense which informs this teaching likewise prevents its expansion to the point of rendering qualified immunity an insignificant aberration or infringing on the settled doctrine that [i]t is not enough, to justify denying immunity, that liability in a particular constellation of facts could have been, or even that it was, predicted from existing rules and decisions.... Liability in that particular set [of facts] must have been established at the time the defendant acted. Id. As the en banc Eleventh Circuit stated in Lassiter: For qualified immunity to be surrendered, pre-existing law must dictate, that is, truly compel (not just suggest or allow or raise a question about), the conclusion for every like-situated, reasonable government agent that what defendant is doing violates federal law in the circumstances. Id. at 1150. These principles have particular force where, as here, resolution of whether the defendant's conduct violated the constitutional provision sued on is heavily dependent on a balancing or weighing against each other of different factors according to the degree they are present in the matrix of facts constituting the particular context in which the asserted violation occurred. See, e.g., Gunaca at 474-75; Noyola v. Texas Department of Human Resources, 846 F.2d 1021, 1025 (5th Cir.1988). 21 See also Lassiter at 1150. 22 75 Considering that Skinner authorized drug tests on a discretionary, ad hoc basis if the employee had been involved in certain rule violations but without further individualized suspicion, that that principle had not (and has not) been held by the Supreme Court or this Court to be dependent on the prior existence of a rule so providing, and that objective factors distinguished Dr. Pierce from other residents in the program so that she was not singled out arbitrarily or capriciously, and considering also the minimal intrusiveness and extent of the invasion of Dr. Pierce's Fourth Amendment interests and the legitimate special needs of the medical school program where she was a student-employee, we conclude that Drs. Smith and Binder are entitled to qualified immunity as a matter of law. The question is not whether other reasonable or more reasonable courses of action were available. It is, rather, whether of medical school officials similarly situated to Drs. Smith and Binder all but the plainly incompetent would have realized at the time that what they did violated Dr. Pierce's Fourth Amendment rights. Hunter at 228, 112 S.Ct. at 537; Blackwell at 304. Under the circumstances, that question must be answered in the negative.