Opinion ID: 1267609
Heading Depth: 2
Heading Rank: 1

Heading: Officer Turensky

Text: The Eighth Amendment prohibits the infliction of cruel and unusual punishments on those convicted of crimes. Wilson v. Seiter, 501 U.S. 294, 296-97, 111 S.Ct. 2321, 115 L.Ed.2d 271 (1991) (quotation omitted). In order to make out an Eighth Amendment violation the offending conduct must be wanton.  Id. at 302, 111 S.Ct. 2321 (emphasis in the original). The word wanton[] does not have a fixed meaning and its meaning in the Eighth Amendment context depends upon the circumstances in which the alleged violation occurs. Id. In cases involving prison riots, for example, wantonness is demonstrated by acting maliciously and sadistically for the very purpose of causing harm. Whitley v. Albers, 475 U.S. 312, 320-21, 106 S.Ct. 1078, 89 L.Ed.2d 251 (1986) (quotation omitted). The Eighth Amendment standard for conditions of confinement and medical care such as those raised here is different, and the constitutional question in this case is whether Turensky acted with deliberate indifference. See Wilson, 501 U.S. at 303, 111 S.Ct. 2321 (quotation omitted). A prison official is deliberately indifferent if she knows of and disregards a serious medical need or a substantial risk to an inmate's health or safety. See Farmer v. Brennan, 511 U.S. 825, 837, 114 S.Ct. 1970, 128 L.Ed.2d 811 (1994). A claim of deliberate indifference has both an objective and a subjective component. See id. at 838-39, 114 S.Ct. 1970. Thus, the relevant questions here are: (1) whether Nelson had a serious medical need or whether a substantial risk to her health or safety existed, and (2) whether Officer Turensky had knowledge of such serious medical need or substantial risk to Nelson's health or safety but nevertheless disregarded it. See id. at 842, 114 S.Ct. 1970. Nelson's expert, Dr. Cynthia Frazier, testified by affidavit to a reasonable degree of medical certainty, that [shackling] is inherently dangerous to both the mother and the unborn fetus and that it may interfere with the response required to avoid potentially life-threatening emergencies for both the mother and the unborn fetus. A factfinder could determine from the record evidence that Turensky disregarded the risks to Nelson by shackling her while she was in the final stages of labor and by keeping her in shackles (except for intervening medical exams) until shortly before her baby was born. To establish an Eighth Amendment violation Nelson need not show that Turensky actually believed that shackling her during labor would harm her, for it is enough that the official acted or failed to act despite [her] knowledge of a substantial risk of serious harm. Farmer, 511 U.S. at 842, 114 S.Ct. 1970. Whether or not Officer Turensky knew that shackling presented a substantial risk to Nelson is a question of fact subject to demonstration in the usual ways, including inference from circumstantial evidence, and a factfinder may conclude that a prison official knew of a substantial risk from the very fact that the risk was obvious. Id. (citation omitted). That Turensky lacked medical training, that the hospital staff did not explicitly forbid the use of shackles, or that Nelson did not expressly state how painful and uncomfortable they were, is thus inconclusive (although at trial it remains open to the official[] to prove that [she was] unaware even of an obvious risk to [Nelson's] health or safety, id. at 844, 114 S.Ct. 1970). A reasonable factfinder could determine that there is substantial evidence of Turensky's own general awareness of the risk of harm from shackling a woman in labor. During her deposition Turensky admitted that, [i]f you've got a very old sickly woman who's had three or four strokes, of course you don't want to put shackles on that inmate. That is just common sense. I do the same thing with pregnant inmates. I would not shackle a pregnant inmate.  (emphasis supplied). When asked what it is about shackling pregnant inmates that bothered her, Turensky responded,  It's not in policy  if it were in policy, I would have to tell them that there's something wrong with the policy.... [4] (emphasis supplied). Turensky also appeared troubled by the fact that you just cannot examine anyone with shackles on. They're not very sanitary.  (emphasis supplied). Finally, Turensky admitted that she  imagine[d] they hurt the ankles when you're lying in bed. (emphasis supplied). Officer Turensky was also put on notice that her actions could interfere with required medical care and aggravate Nelson's already considerable pain and suffering. She had been present when Nelson was forced by powerful contractions to brace herself against the prison wall and when Nurse Smith shouted to officials in the sally port that Nelson had to be taken to the hospital as soon as possible. Turensky was instructed by a prison official to RUSH Nelson to the hospital and to NOT to [sic] take time for cuffs. She was present at the sally port when Nelson required a nurse's assistance and in the maternity ward when Nelson requested an epidural. Turensky noted in her log that Nelson was feeling sick, and she was present while two nurses had to help Nelson push her baby along the birth canal. She was repeatedly required to remove Nelson's shackles so medical personnel could examine her. Turensky was informed by a nurse in the maternity ward that she wished that Nelson was not being restrained by shackles. There is no contradictory evidence suggesting that Turensky's decisions to place the shackles on Nelson initially and to reshackle her after each medical examination were made in reliance on the judgment of medical personnel. No medical personnel ever requested that Nelson be shackled or requested their reapplication following an examination. Indeed, repeated requests to unshackle Nelson to permit medical examinations and at least one explicit expression of dissatisfaction with the shackling (nurse who wished Nelson might remain unshackled) are evidence of a medical judgment that Nelson should not have been shackled at all while in the final stages of labor. Moreover, there is nothing in the record to indicate that any medical personnel other than Dr. Hergenroeder believed they could demand that the shackles be set aside. On the contrary, the fact that Turensky continued to reshackle Nelson after one nurse expressed her wish that Nelson not be shackled could have reasonably led other medical personnel to believe that Turensky would not be influenced by their wishes. From all this evidence a factfinder could draw the inference that Turensky recognized that the shackles interfered with Nelson's medical care, could be an obstacle in the event of a medical emergency, and caused unnecessary suffering at a time when Nelson would have likely been physically unable to flee because of the pain she was undergoing and the powerful contractions she was experiencing as her body worked to give birth. See Heidi Murkoff et al., What to Expect When You're Expecting 364-67 (3d ed.2002) (pain, nausea, vomiting, exhaustion, oxygen deprivation, and inability to walk are incident to final stages of labor). [5] While deliberate indifference to a prisoner's serious illness or injury can typically be established or disproved without the necessity of balancing competing institutional concerns for the safety of prison staff, Whitley, 475 U.S. at 320, 106 S.Ct. 1078, from the record evidence in Nelson's case there does not even appear to have been a competing penological interest in shackling her, see, e.g., Hope, 536 U.S. at 738, 122 S.Ct. 2508 (Despite the clear lack of an emergency situation, the respondents knowingly subjected [petitioner] to a substantial risk of physical harm. ...). According to Turensky's own testimony, Nelson was not threatening or belligerent at any point. Turensky responded [n]o when asked whether Nelson sa[id] or d[id] anything that made [her] think she was an escape risk. Nurse Smith testified that Nelson was [e]xtremely quiet, very nice, never caused any problems. I never had any trouble with her. Moreover, according to Turensky's own notes, Nelson required the assistance of medical staff to push her unborn child along the birth canal, to complete the process of separation of mother and child that is birth. Turensky also recorded in her log that Nelson became ill during the course of labor. A reasonable factfinder could determine from the record evidence that Nelson did not present a flight risk while under the supervision of Turensky, an experienced correctional officer who was equipped with a fire arm. Turensky's statement during discovery that she had doubts and was a tad nervous because Nelson was talking about how she should not be considered an inmate because she was in the free world in a free-world hospital does not compel a different conclusion. A factfinder viewing that statement in the light most favorable to Nelson, as it be must on summary judgment, Plemmons, 439 F.3d at 822, could very well interpret it as Nelson's expressed wish to be able to give birth in the normal manner without being shackled to the bed. Moreover, summary judgment is prohibited where there are contradictory facts relevant to the issue of qualified immunity. Tlamka, 244 F.3d at 632.
Having determined that there is sufficient evidence in the record to permit a reasonable factfinder to determine that Turensky's actions violated the Eighth Amendment, the question remains whether such a constitutional right was clearly established in September 2003. A constitutional right is clearly established if its contours are sufficiently clear that a reasonable official would understand that what he is doing violates that right. This is not to say that an official action is protected by qualified immunity unless the very action in question has previously been held unlawful. ... Hope, 536 U.S. at 739, 122 S.Ct. 2508 (quotation omitted). The Supreme Court has made it clear that there need not be a case with `materially' or `fundamentally' similar facts in order for a reasonable person to know that his or her conduct would violate the constitution. Young v. Selk, 508 F.3d 868, 875 (8th Cir.2007) ( quoting Hope, 536 U.S. at 741, 122 S.Ct. 2508). Instead, the unlawfulness must merely be apparent in light of preexisting law. Hope, 536 U.S. at 739, 122 S.Ct. 2508, and officials can still be on notice that their conduct violates established law even in novel factual circumstances. Id. at 741, 122 S.Ct. 2508. Notice of constitutionally impermissible conduct may be provided by the Constitution itself or the decisions of the United States Supreme Court and the lower federal courts. See Hope, 536 U.S. at 741-42, 122 S.Ct. 2508. Prison regulations governing the conduct of correctional officers are also relevant in determining whether an inmate's right was clearly established. Treats v. Morgan, 308 F.3d 868, 875 (8th Cir.2002). A review of these sources confirms that the constitutional right asserted by Nelson was clearly established in September 2003. The Eighth Amendment prohibits cruel and unusual punishments, U.S. Const. amend. VIII, and well before September 20, 2003 the Supreme Court and the lower federal courts had concluded that the Amendment forbids actions like those taken by Turensky in shackling Nelson. In 2002, the Supreme Court provided guidance to officials on the constitutional limits in restraining prisoners in a § 1983 action brought by an inmate alleging that his Eighth Amendment rights had been violated by officials responsible for handcuffing him to a prison hitching post. Hope, 536 U.S. at 733-35, 122 S.Ct. 2508. The Court determined that defendant prison officials had acted with deliberate indifference to the inmate's health and safety in violation of the Eighth Amendment by restraining him [d]espite the clear lack of an emergency situation in a manner that created a risk of particular discomfort and humiliation. Id. at 737-38, 122 S.Ct. 2508. A reasonable factfinder could determine from the record in this case that Officer Turensky, like the Hope officials, was not facing an emergency situation but nevertheless subjected [Nelson] to a substantial risk of physical harm, to the unnecessary pain caused by the [shackles] and the restricted position of confinement ... [and] created a risk of particular discomfort and humiliation. See id. at 738, 122 S.Ct. 2508. [6] The general responsibilities of state officers with regard to an inmate's medical needs were also clearly established before September 2003. In 1976 the Supreme Court had decided Estelle v. Gamble, 429 U.S. 97, 97 S.Ct. 285, 50 L.Ed.2d 251 (1976), a leading case in the development of Eighth Amendment law. Estelle was a § 1983 action brought against prison officials for providing an inmate inadequate medical care. Id. at 98, 97 S.Ct. 285. The Court concluded that either interference with care or infliction of unnecessary suffering establishes deliberate indifference in medical care cases in violation of the Eighth Amendment. Id. at 103-05, 97 S.Ct. 285. Whether an official such as Turensky interfered with Nelson's medical care or inflicted unnecessary suffering on her is a question squarely raised by the evidence in the record before this court. See, e.g., Farmer, 511 U.S. at 842, 114 S.Ct. 1970 (official violates Eighth Amendment in condition of confinement cases where he act[s] or fail[s] to act despite his knowledge of a substantial risk of serious harm); Tlamka, 244 F.3d at 633 (Eighth Amendment violated in medical care cases where official disregards obvious risk to inmate); Coleman v. Rahija, 114 F.3d 778, at 786 (8th Cir.1997) (official violates pregnant inmate's Eighth Amendment rights when she fails to act in the face of an obvious[] risk of harm). Moreover, the precise issue under consideration here was decided years ago by a federal district court in the District of Columbia. In 1994 that court held that [w]hile a woman is in labor ... shackling is inhumane and violates her constitutional rights. Women Prisoners of D.C. Dep't of Corr. v. District of Columbia, 877 F.Supp. 634, 668-69 (D.D.C.1994), modified in part on other grounds, 899 F.Supp. 659 (D.D.C.1995). The court held defendant prison officials liable, explaining that a prison official who shackles a woman in labor acts with deliberate indifference ... since the risk of injury to women prisoners is obvious. Id. at 669. The court found it significant that one prison official had shackled a pregnant inmate even though he himself later stated that he would not shackle a third trimester woman, from which the court concluded that he recognize[d] the risk. Id. Turensky's similar admission could also be found to show that she applied the leg restraints on Nelson despite recognizing the risks involved in shackling her during labor. These constitutional holdings in Women Prisoners were never appealed and they remained in effect at the time Nelson went into labor. See Women Prisoners of D.C. Dep't of Corr. v. District of Columbia, 93 F.3d 910 (D.C.Cir.1996). Although an Eighth Amendment claimant need not identify a factually identical case to satisfy the clearly established requirement, see Hope, 536 U.S. at 739, 122 S.Ct. 2508 (quoting Anderson, 483 U.S. at 640, 107 S.Ct. 3034), it is beyond question here that a federal court had found constitutional violations on essentially the same facts some seven years earlier in a widely reported decision. The value of that precedent was supported by the government's decision not to contest these constitutional holdings in its appeal to the D.C. Circuit, and the circuit court expressed no concern about them in its review of the record. Women Prisoners, 93 F.3d at 918. Nelson's protections from being shackled during labor had thus been clearly established by decisions of the Supreme Court and the lower federal courts before September 2003. The ADC administrative regulations in effect also reflected the constitutional protections recognized in these judicial decisions. [7] Regulation 403, for example, prescribed restraints  only when circumstances require the protection of inmates, staff, or other individuals from potential harm or to deter the possibility of escape. Ark. Dep't of Corr. Admin. Reg. 403 § V (1992) (emphasis supplied). In addition, Administrative Directive 95:21 required a transportation officer taking an inmate to a hospital for a medical emergency such as childbirth to use good judgment in balancing security concerns with the wishes of treatment staff and the medicine needs of the inmate. Ark. Dep't of Corr. Admin. Dir. 95:21 § IV(B)(4)(c) (1995) (emphasis supplied). If security concerns could conflict with an inmate's medical needs, transportation officers were required to seek guidance from their superiors. Id. Nothing in the ADC's regulation or directive suggested that officials were required to shackle pregnant inmates who were in the final stages of labor in a civilian hospital. [8] Since these rules were in effect when Turensky was hired, trained, and retrained and remained in effect when she accompanied Nelson to the hospital, her knowledge of them is presumed and they applied to her decisions and actions in September 2003. See Harlow v. Fitzgerald, 457 U.S. 800, 818-19, 102 S.Ct. 2727, 73 L.Ed.2d 396 (1982) (a reasonably competent public official should know the law governing his conduct). In addition to this presumption of knowledge, the record indicates that Turensky had actual knowledge that any competing interests must be balanced. As she explained, [i]f you've got a very sickly old woman who's had three or four strokes, of course you don't want to put shackles on that inmate. That is just common sense. I do the same thing with pregnant inmates. The record suggests that a factfinder could determine that Turensky entirely disregarded her duty to balance these competing concerns. A fair reading of the record, including Turensky's testimony, establishes that Nelson did not present a flight risk or other security concern and that at least one medical professional considered the shackles to be an interference with her medical needs. Moreover, Turensky's own testimony indicates that she was aware that shackling a woman in labor was hazardous and contrary to medical needs. There is no evidence that she utilized any of this information to balanc[e] security concerns with the wishes of treatment staff and the medicine needs of the inmate as required by prison regulations. See Ark. Dep't of Corr. Admin. Dir. 95:21 § IV(B)(4)(c) (1995). Nor is there any evidence that she contacted her superiors for guidance. See id. Existing constitutional protections, as developed by the Supreme Court and the lower federal courts and evidenced in ADC regulations, would have made it sufficiently clear to a reasonable officer in September 2003 that an inmate in the final stages of labor cannot be shackled absent clear evidence that she is a security or flight risk. Indeed, [t]he obvious cruelty inherent in this practice should have provided [Turensky] with some notice that [her] alleged conduct violated [Nelson's] constitutional protection against cruel and unusual punishment. [Nelson] was treated in a way antithetical to human dignity ... and under circumstances that were both degrading and dangerous. Hope, 536 U.S. at 745, 122 S.Ct. 2508. For these reasons, the district court did not err in concluding that the constitutional rights asserted by Nelson were clearly established at the time. Our obligation at this stage of the case is not to resolve the ultimate issue of whether Shawanna Nelson can prevail on her § 1983 claims against Officer Turensky. Our task is only to examine the record before the district court to determine whether it erred in denying the officer qualified immunity under the relevant summary judgment standard. See Plemmons, 439 F.3d at 822. Since Nelson produced sufficient evidence to demonstrate that Officer Turensky violated her clearly established Eighth Amendment rights by shackling her during labor, the basic concept underlying the Eighth Amendment [being] nothing less than the dignity of [wo]man, Hope, 536 U.S. at 738, 122 S.Ct. 2508 (quotation omitted), the judgment of the district court denying Officer Turensky qualified immunity is affirmed.