Opinion ID: 799337
Heading Depth: 4
Heading Rank: 1

Heading: Special Relationship Exception (Counts One and Eleven)

Text: Counts One and Eleven of the complaint allege that Defendants have violated Plaintiffs' right to be free from harm while involuntarily in government custody and their right to medical care, treatment, and services. Count One seeks damages and injunctive relief for the individual plaintiffs and Count Eleven seeks injunctive relief on behalf of a class of foster children who have failed to receive early intervention services that they are entitled to under federal law. Both counts proceed to provide more detailed factual allegations. Count One provides a list of the conduct that allegedly has violated Plaintiffs' rights to adequate safety and medical care: (a) failure to adequately provide medical, dental, and mental health services, including but not limited to standardized periodic health screenings and treatments, medical services for maximum reduction of physical or mental disability, and monitoring of, administration, and use of psychotropic drugs by foster children; (b) failure to inform caregivers of essential information; (c) failure to conduct legally required visits with foster children; (d) failure to adequately respond to reports of abuse; (e) failure to ensure adequacy of relative caregiver placements; and (f) failure to adequately inspect out of state facilities and monitor treatment and services provided to foster children placed in out of state facilities. Count One also incorporates the detailed examples of how Defendants failed to provide adequate medical care and safety to the individual plaintiffs, such as the failure to approve Jonathan's necessary medical treatment despite knowledge that he was seriously ill; the failure to provide Olivia's foster parents with the information and authorization to fill her prescriptions; and the failure to respond to reports of abuse and neglect at Linda and Mason's foster care placements. Count Eleven alleges that Defendants' routine failure to refer eligible children to early intervention services amounts to a denial of adequate medical care. The district court dismissed Counts One and Eleven after concluding that Defendants were entitled to qualified immunity because Plaintiffs failed to allege a violation of a clearly established constitutional right. The district court explained that while the State must provide individuals in state custody with their basic human needs, the specific examples of medical care and services listed by Plaintiffs were not clearly established constitutional rights. This conclusion is plainly wrong with respect to Plaintiffs' damages claim against Clark County and Plaintiffs' claims for injunctive relief. Qualified immunity shields federal and state officials from money damages unless a plaintiff pleads facts showing (1) that the official violated a statutory or constitutional right, and (2) that the right was `clearly established' at the time of the challenged conduct. Ashcroft v. al-Kidd, ___ U.S. ____, 131 S.Ct. 2074, 2080, 179 L.Ed.2d 1149 (2011) (emphasis added). Qualified immunity is not available as a defense in § 1983 cases against a municipality or against individuals where injunctive relief is sought instead of or in addition to damages. Pearson v. Callahan, 555 U.S. 223, 242, 129 S.Ct. 808, 172 L.Ed.2d 565 (2009). Defendants do not dispute the law on this point. We therefore reverse the district court's dismissal of Count Eleven, which seeks only injunctive relief, and reverse the dismissal of Count One with respect to the claims for injunctive relief and the damages claim against Clark County. Qualified immunity simply does not apply to these claims. [5] Qualified immunity is, however, a possible defense to the claims for damages against the individual defendants in Count One. Even if a complaint sufficiently alleges that a government official violated a federal constitutional or statutory right, that official is entitled to qualified immunity from money damages if the right was not clearly established at the time of the challenged conduct. See al- Kidd, 131 S.Ct. at 2080. A Government official's conduct violates clearly established law when, at the time of the challenged conduct, the contours of a right are sufficiently clear that every reasonable official would have understood that what he is doing violates that right. Id. at 2083 (internal quotation marks and alterations omitted). 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, but it is to say that in the light of pre-existing law the unlawfulness must be apparent. Hope v. Pelzer, 536 U.S. 730, 739, 122 S.Ct. 2508, 153 L.Ed.2d 666 (2002) (internal citations omitted). In this case, the district court's qualified immunity analysis was too narrow. The district court looked at Plaintiffs' detailed factual allegations and essentially determined that Defendants were entitled to qualified immunity because the very action[s] in question had not previously been held unlawful. See id. Instead, the district court should have (1) determined the contours of a foster child's clearly established rights at the time of the challenged conduct under the special relationship doctrine of substantive due process, and (2) examined whether a reasonable official would have understood that the specific conduct alleged by Plaintiffs violated those rights. See al- Kidd, 131 S.Ct. at 2083. Using the correct analysis, we conclude that Plaintiffs have alleged violations of their clearly established constitutional rights, and the individual defendants are not entitled to qualified immunity at this stage of the litigation. It is clearly established that when the State takes a person into its custody and holds him there against his will, the Constitution imposes upon it a corresponding duty to assume some responsibility for his safety and general well-being. DeShaney, 489 U.S. at 199-200, 109 S.Ct. 998. When the State asserts this type of custody over a person and at the same time fails to provide for his basic human needs e.g., food, clothing, shelter, medical care, and reasonable safetyit transgresses the substantive limits on state action set by ... the Due Process clause. Id. at 200, 109 S.Ct. 998. It is also clearly established that this special relationship doctrine applies to children in foster care. We recently clarified that it has been clearly established since at least 1996 that foster children have a federal constitutional right to state protection while they remain in the care of the State. Tamas v. Dep't of Soc. & Health Servs., 630 F.3d 833, 846-47 (9th Cir.2010). Our circuit recognized the State's duty to protect foster children as early as 1992, when we observed that [o]nce the state assumes wardship of a child, the state owes the child, as part of that person's protected liberty interest, reasonable safety and minimally adequate care and treatment appropriate to the age and circumstances of the child. Lipscomb v. Simmons, 962 F.2d 1374, 1379 (9th Cir.1992). All of the conduct challenged here occurred after 1996, so there is no question that a foster child's right to the basic needs identified in DeShaney food, clothing, shelter, medical care, and reasonable safetywas clearly established at the time of the challenged conduct. See al- Kidd, 131 S.Ct. at 2080. We can further clarify the contours of this right by looking to our recent decision in Tamas. First, Tamas itself held that this right encompasses a foster child's liberty interest in social worker supervision and protection from harm inflicted by a foster parent. 630 F.3d at 842. Tamas also clarified that the proper standard for determining whether a foster child's due process rights have been violated is deliberate indifference, the same standard applied to substantive due process claims by prisoners. Id. at 844-45. This standard requires an objective risk of harm and a subjective awareness of that harm. Id. at 844 (quoting Conn v. City of Reno, 591 F.3d 1081, 1095 (9th Cir.2010)). To be more specific, it requires (1) a showing of an objectively substantial risk of harm; and (2) a showing that the officials were subjectively aware of facts from which an inference could be drawn that a substantial risk of serious harm existed and (a) the official actually drew that inference or (b) that a reasonable official would have been compelled to draw that inference. Id. at 845. [T]he subjective component may be inferred from the fact that the risk of harm is obvious. Id. (internal quotation marks and citation omitted). Second, we can look to the clearly established law from other circuits cited by the Tamas court. Those cases demonstrate, for example, that a foster child's due process rights are violated when a state official exhibits deliberate indifference to a child's serious medical needs, Norfleet v. Ark. Dep't of Human Servs., 989 F.2d 289, 291 (8th Cir.1993); to suspected physical abuse in a foster home, Hernandez v. Tex. Dep't of Protective and Regulatory Servs., 380 F.3d 872, 881 (5th Cir.2004); and to suspected sexual abuse in a foster home, J.H. v. Johnson, 346 F.3d 788, 791 (7th Cir.2003). Because the substantive due process rights of foster children are analogous to those of prisoners, see Tamas, 630 F.3d at 844-45, we can also look to our prisoner cases to further define what constitutes a serious medical need. Those cases, for example, have held that ignoring the instructions of a treating physician, or failing to provide a prisoner with necessary psychotropic medication, can amount to deliberate indifference to serious medical needs. Wakefield v. Thompson, 177 F.3d 1160, 1164-65 (9th Cir.1999). Having examined the relevant contours of a foster child's clearly established due process rights to adequate safety and medical care, we conclude that a reasonable official would have understood that at least some of the specific conduct alleged by Plaintiffs violated those rights. Count One of the complaint alleges generally that Defendants exhibited deliberate indifference and violated the children's rights to be free from harm while involuntarily in government custody and their right to medical care; alleges more specifically that Defendants failed to provide adequate medical care, monitor the administration of medication, or respond to reports of abuse; and provides detailed factual allegations relating to the individual plaintiffs. A reasonable official would have understood that failing to authorize Jonathan's medical treatment despite knowledge of his serious illness and repeated requests from his treating physician amounted to deliberate indifference to a serious medical need. A reasonable official would also have understood that failing to respond to Linda's reports of physical abuse in her foster home or the numerous reports of abuse in Mason's out-of-state placement would constitute deliberate indifference to the children's right to safety in their foster care placements. It may be that Plaintiffs cannot prove these allegations, or that they can only prove some of their less serious allegations, such as the failure to provide standardized periodic health screenings. If that turns out to be the case, the individual defendants can again raise the defense of qualified immunity at a later stage in the proceedings. See Ortiz v. Jordan, ___ U.S. ___, 131 S.Ct. 884, 889, 178 L.Ed.2d 703 (2011). But at this stage, when we accept as true all well pleaded facts in the complaint, Plaintiffs have alleged violations of their clearly established constitutional rights, and qualified immunity is not appropriate. We reverse the district court's dismissal of the damages claims in Count One.