Opinion ID: 223425
Heading Depth: 3
Heading Rank: 2

Heading: Violation of the Constitutional Right

Text: In light of the clearly established law that hospital officials must provide safe conditions for involuntarily committed patients, we now examine the circumstances under which state hospital officials may be held responsible for failing to do so. We previously applied the Youngberg professional judgment standard in Neely, 50 F.3d at 1507, a case with facts remarkably similar to those presented here. There, a female patient (Neely), who had been allegedly molested by a hospital staff member (Terry), sued state mental hospital administrators and staff. Neely named as defendants Feinstein, the hospital superintendent; Hosley, the Director of Nursing; Murgo, the chairperson of the committee assigned to investigate prior accusations against Terry; and Brown, the building supervisor. Id. at 1506-07. Prior to Neely's allegations, two other patients had also alleged that Terry had sexually assaulted them. Id. at 1505. In response to both prior incidents, Feinstein convened a committee to investigate the allegations and, both times, the committee determined there was no evidence to substantiate the allegations against Terry. Id. at 1506. After the second investigation concluded, however, Feinstein issued a reprimand to Terry for showing very poor judgment in placing himself in situations where he was alone with female patients. Id. Hosley issued an oral directive barring Terry's assignment to work in the women's ward and in one-to-one seclusion with female patients. Hosley later lifted this restriction, and Brown assigned Terry to work in one-on-one seclusion with Neely. It was then that Terry's alleged assault of Neely occurred. Id. at 1506. In our analysis, we first acknowledged that the Youngberg professional judgment standard served as clearly established law at the time of the alleged abuse. Id. at 1507. We recognized that, in O'Connor, 846 F.2d at 1208, another case involving a patient grievously harmed in a state-run mental hospital, we applied the objective Youngberg standard and equated it `to that required in ordinary tort cases for a finding of conscious indifference amounting to gross negligence.' Neely, 50 F.3d at 1507 (quoting O'Connor, 846 F.2d at 1208) (emphasis added). [6] We further explained that this conscious indifference standard is not the same as the deliberate indifference standard used in the Eighth Amendment cruel and unusual punishment context and extended to alleged violations of pre-trial detainees' rights under the Fourteenth Amendment. Id. We therefore rejected the argument that the applicable standard of conscious indifference required the plaintiff to show that the officials were subjectively aware of the risk posed to the patient, noting that although a subjective awareness requirement comported with the Eighth Amendment's proscription against cruel and unusual punishment, there is no such requirement to enforce patient rights arising from the Fourteenth Amendment. Id. at 1508. [7] Accordingly, we recognized that the Youngberg professional judgment standard is necessarily an objective test. Id. (emphasis added). [8] We concluded that, at the time of the hospital officials' actions, the law in this circuit clearly established that (1) patients have a constitutional right to be safe in the state institution to which they are committed, and that (2) in the face of known threats to patient safety, state officials may not act (or fail to act) with conscious indifference, but must take adequate steps in accordance with professional standards to prevent harm from occurring. [9] Id. Pursuant to this framework, we affirmed the district court's denial of qualified immunity for Feinstein on the ground that he summarily disregarded the risk that Terry, a hospital employee previously accused of sexual molestation, would sexually abuse female patients. The evidence supported a finding that Feinstein failed to exhibit vigilance in protecting the safety of female patients, and that a reasonable hospital official would have done much more to eliminate the risk that Terry would sexually abuse female patients under the hospital's care. Id. at 1509. Murgo, the chairperson of the committee convened to investigate the prior allegations against Terry, was found qualifiedly immune. Id. at 1511. We reasoned that, although the committee did not interview certain witnesses, it did interview those witnesses required by hospital regulations. Id. Hosley, who informed the shift supervisors that Terry should not be assigned to the women's ward or to one-on-one seclusion with female patients, was found qualifiedly immune. Id. Although Hosley did not put this directive in writing, she did not act unreasonably because Feinstein, her supervisor, did not instruct her to do so. Id. Additionally, there was no evidence that Hosley was informed of the evidence of Terry's prior sexual assaults, which Feinstein had reviewed. Id. Hosley's lack of awareness of the prior accusations against Terry was relevant to our assessment of the reasonableness of her actions, although it was not the basis for finding her qualifiedly immune. Brown, the building supervisor assigned to the women's ward, was found qualifiedly immune because he had assigned Terry to the women's ward only after the restriction was lifted and in light of a staff shortage. Id. We held that Brown could not have been said to have acted unreasonably. Id. In sum, we held the lower-level supervisors qualifiedly immune due to their compliance with hospital regulations and supervisory guidance and directives (to the extent such directives were issued), and because their conduct was reasonable in light of practical considerations. Feinstein was found subject to liability because, as head of the hospital, he failed to act to protect the safety of patients through effectively guiding lower-level supervisors to reduce the safety risk posed by Terry. Contrary to the dissent's assertions, there is nothing contradictory about this resolution. Youngberg and Neely serve as pre-existing, clearly established law as to what conduct supports infringement of the Fourteenth Amendment rights of involuntarily committed hospital patients. At the time of the alleged events, then, it was clear that the actions of LaFond and Webster violated the Constitution if they ran afoul of the objective Youngberg professional judgment [10] standard as applied in Neely. [11]