Opinion ID: 539921
Heading Depth: 2
Heading Rank: 2

Heading: liability of the defendants

Text: 40 Of course, Wood must show more than a violation of his constitutional rights; to prevail under section 1983 he must show that Housewright and Sumner are persons who, under color of state law, subjected him, or caused him to be subjected, to the deprivation of those rights. 42 U.S.C. Sec. 1983. After concluding that Wood had not proven any constitutional violations, the district court held as an alternative ground for its judgment that neither Housewright nor Sumner could be charged with liability even if there were a constitutional violation. 41 The district court arrived at this alternative ground after considering two possible theories of liability under section 1983: 42 The liability of Mr. Housewright and Mr. Sumner must be found in their actual participation in the deprivation of the constitutional rights of plaintiff or their encouragement of such deprivation. At a minimum plaintiff must show that these officials directly or implicitly authorized, approved, or knowingly aquiesced in the alleged unconstitutional conduct. Buckner v. State of Nevada, 599 F.Supp. 788, 791 (D.Nev.1984); see Hoptowit v. Ray, 682 F.2d 1237, 1252-54 (9th Cir.1982); Hirst v. Gertzen, 676 F.2d 1252, 1263 n. 28 (9th Cir.1982). One other possible basis for liability of the defendants must be pursued and that is whether there is any specific statute of Nevada or regulation of the State Prison Board or [Nevada Department of Prisons] which would impose a duty upon either of them, the violation of which could result in liability. 43 The district judge rejected the first theory of liability because he found no credible evidence to support the allegation that either Housewright or Sumner knew about Wood's medical problems prior to May 4, 1983, when Wood's medical needs were finally met. 10 The court rejected the second theory because it found that the state statutes imposing affirmative duties upon Housewright and Sumner do not, in the court's words, make [them] absolutely liable for everything that happens in the prison respecting the health of inmates. 44 On both points, the district court's legal analysis was incorrect. We have summarized the possible bases of liability under section 1983 as follows: 45 A person subjects another to the deprivation of a constitutional right, within the meaning of section 1983, if he does an affirmative act, participates in another's affirmative acts, or omits to perform an act which he is legally required to do that causes the deprivation of which complaint is made.... Moreover, personal participation is not the only predicate for section 1983 liability. Anyone who causes any citizen to be subjected to a constitutional deprivation is also liable. The requisite causal connection can be established not only by some kind of direct personal participation in the deprivation, but also by setting in motion a series of acts by others which the actor knows or reasonably should know would cause others to inflict the constitutional injury. 46 Johnson v. Duffy, 588 F.2d 740, 743-44 (9th Cir.1978) (emphasis added). Under this standard, the district court's analysis was deficient in a number of respects, at least some of which require reversal. I need mention only two critical deficiencies. 47 First, the court's statement of the law was erroneous. Personal liability under section 1983 need not be based upon authorization, approval, or acquiescence; it is sufficient if the defendant omits to perform an act which he is legally required to do that causes the deprivation of which complaint is made. 588 F.2d at 743. Knowledge of Wood's medical needs, while possibly relevant to the question of whether the defendants authorized, approved, or acquiesced in the deliberate indifference to those needs, has no bearing on whether the defendants failed to perform an act they were legally required to perform, or whether that failure caused Wood's injury, either directly or indirectly. Thus, the finding that neither Housewright nor Sumner knew about Wood's medical needs was not sufficient to insulate them from liability. 48 Second, although the court appears to have realized that liability could rest upon a breach of duties imposed by state law, the court failed to give sufficiently concrete content to the broad duties which Nevada law imposes upon Housewright and Sumner. The district judge mentioned only the abstract policy of provid[ing] care for inmates equivalent, so far as possible, to that provided for free citizens in the outside world. He failed to identify the specific acts required of the defendants in order to fulfill their broad, general obligations under the pertinent Nevada statutes. In short, the court failed to consider whether the specific measures taken by the two officials were adequate or whether by failing to adopt certain policies or procedures they violated their statutory obligations. 49 With the proper legal standards in mind, I find two ways in which Housewright and Sumner may well have been liable for Wood's constitutional injuries. I discuss each in turn. 50
Medical Records 51 Wood contends that Director Housewright and Warden Sumner were ultimately responsible for the transfer of his medical records. If Wood seeks to hold Housewright and Sumner liable for every failure to obtain records, then his theory goes too far. Nonetheless, it is clear that, at a minimum, Nevada law makes the two officials responsible for establishing policies or procedures designed to ensure that the medical records of prisoners are obtained promptly. 52 Section 209.131 of the Nevada Revised Statutes imposes a number of affirmative obligations upon the Director of the Department of Prisons that are pertinent here. The Director is to [r]eceive ... in accordance with law offenders sentenced to imprisonment in the state prison; to [b]e responsible for the supervision, custody, treatment, care, security and discipline of all offenders under his jurisdiction; to [e]stablish regulations ... and enforce all laws governing the ... custody, care and training of offenders; and to [t]ake proper measures to protect the health and safety of ... offenders in the institutions and facilities of the department. Nev.Rev.Stat. Sec. 209.131(3)-(6) (1987) (emphasis added). To facilitate the discharge of these important obligations, the Director is to appoint a warden for each institution. Each warden is responsible to the director for the administration of his institution, including the execution of all policies and the enforcement of all regulations of the department pertaining to the custody, care and training of offenders under his jurisdiction. Nev.Rev.Stat. Sec. 209.161(3) (1987) (emphasis added). Moreover, Nevada Department of Prisons Administrative Regulation 600(V)(C)(3), cited by the district court, charges the warden of each institution with ultimate responsibility for the welfare of the inmates in the institution and for insuring that the inmates have the level of health services commensurate with contemporary medical practice  (emphasis added). 53 These general statutory duties encompass the specific duty to establish policies and procedures by which inmates' medical records are obtained upon transfer or promptly thereafter. Given the fact that inmates may not be treated at NSP without their medical records, and the fact that treatment can in any event best be prescribed if records are available for review, Sumner could insur[e] that the inmates have the level of health services commensurate with contemporary medical practice, id., only by taking reasonable steps to see that medical records are generally obtained at the earliest practicable date. Similarly, Housewright could scarcely be thought to have taken proper measures to protect the health and safety of ... offenders in the institutions and facilities of the department, Nev.Rev.Stat. Sec. 209.131(6), unless he established policies or procedures designed to ensure that the medical record prerequisite for care and treatment would generally be satisfied. Hence, these statutes leave little doubt that the State delegated constitutional duties regarding the obtaining of medical records to Housewright and Sumner. 54 This obviously does not amount to making the warden or the director absolutely liable for everything that happens in the prison in respect to the health of an inmate, as the district court apparently feared. For example, Housewright and Sumner could hardly have been blamed here if Dr. McLennan, after looking at Wood's medical records, had negligently failed to arrange for removal of the broken pin. Likewise, if Wood's records had been promptly requested pursuant to a constitutionally adequate procedure, but the records had been lost by the Las Vegas physician who inserted the pins, there would be no basis for a finding that Housewright or Sumner had breached the duties delegated to them by the Nevada legislature. Similarly, if the institution in possession of the records refused to forward them to the prison, the prison officials could not be held liable. But Wood's argument here is that Housewright and Sumner established no policies or procedures for obtaining medical records in a timely fashion, and that the two officials were therefore in breach of their duties. This does not make the defendants absolutely liable for all record errors; it only makes them responsible for establishing and administering policies designed to safeguard constitutional rights. If they fail to fulfill this responsibility and their failure causes injuries to others, either directly or by setting in motion a series of acts by others, Johnson, 588 F.2d at 743, then they are liable to those injured. 55 It is still necessary to ask whether Housewright and Sumner properly discharged their obligations. The district court concluded that [t]here was nothing deficient in the 'measures' or policies of the director, and that [n]either NRS 209.161 nor NDOP AR 600(V)(C)(3) is a source of liability on the part of Warden Sumner in this case. However, it appears from the court's order that the district judge failed to base his conclusions on any policies more specific than the prison's broad policy of endeavor[ing] to provide care for inmates equivalent, so far as possible, to that provided for free citizens in the outside world. That broad policy is laudable, of course, but it cannot be thought sufficient to cut off any more searching eighth amendment analysis. To determine the liability of Housewright and Sumner in this case, the court should have examined the procedures by which the NSP officials sought to ensure the general availability of medical records. If no such procedures were in place, or if the procedures in place made it foreseeable that new inmates such as Wood would be subjected to indefinite periods of suffering while their records were belatedly obtained, then Housewright and Sumner violated their duties under State law. If so, then their omi[ssion] to perform an act which [they were] legally required to do, Johnson, 588 F.2d at 743, which omission caused the harm sustained by Wood, makes them liable under section 1983. 56 The record strongly suggests that there were in fact no policies or procedures governing the obtaining of prisoners' medical records in advance of the onset of a prisoner's injury or suffering. Wood's contention that he was not presented with a release form until April 22, 1983 is unrefuted in the record, and there is likewise no dispute concerning the fact that Wood's records had not been obtained at that time. If it had been standard procedure for an inmate's medical records to be transferred with the inmate, or shortly thereafter, then it is curious that neither the prison official who admitted Wood on March 11, nor the medical staff at any time prior to April 22, took any steps to correct that deficiency. The obvious inference is that the absence of Wood's medical records was standard operating procedure. 11 If so--and there is nothing in the record to suggest the contrary--then the standard operating procedure is constitutionally unacceptable, and Housewright and Sumner should be held liable under section 1983 for deliberate indifference to Wood's serious medical needs. 57 However, although the evidence clearly suggests the defendants' liability, it is for the district court to evaluate the relevant testimony in the first instance. Therefore, I believe that the proper disposition on appeal would be to reverse and remand for further proceedings. For the record, I would have encouraged the district judge to reopen the proceedings and allow the parties to adduce additional testimony on, among other things, the general procedures, if any, by which medical records are obtained at NSP; in fact, for the reasons noted below, I would have suggested that the district judge consider granting a new trial. 58 Judge Reed did a commendable job of accommodating a pro se plaintiff; he properly attempted to assist Wood in the complex task of developing the evidence necessary to substantiate his claims; and I have nothing but praise for the way Judge Reed balanced his concern for orderly proceedings with his desire that the truth be reached. Nonetheless, there appears to be a strong possibility that Wood's questioning was unduly influenced by the judge's failure to appreciate the nature of Housewright's and Sumner's responsibilities under Nevada law, and that as a result, the record may not have been properly developed. 12 Moreover, both the record and various statements of the defendants' counsel suggest that constitutionally inadequate procedures may be in place even now at NSP, and perhaps elsewhere in the Nevada prison system. That is a possibility that should not be dismissed without further inquiry. 59
Medical Supplies and Equipment 60 The absence of medical records was not the sole cause of Wood's injuries; the confiscation of his sling was also a substantial, and indeed seminal, cause of his subsequent pain and suffering. Wood contends that Housewright and Sumner must also bear responsibility for this instance of deliberate indifference. For many of the same reasons as those expressed above, I agree. 61 As explained earlier, official interference with prescribed medical treatment, in the absence of strong justification, constitutes deliberate indifference. It would make little sense to hold that sections 209.131 and 209.161 impose a duty to facilitate medical treatment while holding at the same time that those sections impose no duty to proscribe official interference with such treatment. Since there is every reason to expect that some prisoners will arrive at the prison with canes, crutches, slings, or medications, it seems evident that some policies and procedures regulating the possession and use of those items are necessary. Any such policies and procedures, of course, must ensure that prisoners are not wrongfully deprived of necessary medical supplies or equipment upon their arrival. For the reasons explained earlier, Housewright and Sumner were responsible for establishing and enforcing such policies and procedures. The failure to discharge this responsibility, where it leads to constitutional injury as it did here, is sufficient to support liability under section 1983. 62 The question again becomes whether Housewright and Sumner properly discharged their duty. Again, I believe the evidence suggests that they did not. Officer Christy testified that confiscation was left to the discretion of the sergeant or whoever was in charge that day. Furthermore, Sumner testified, in response to questioning by Wood, that there were no procedures governing the confiscation of medically necessary equipment when inmates were received into the prison. Cf. Nev.Rev.Stat. Sec. 209.131(3) (requiring the Director to receive [offenders] according to law). Although Sumner also testified that it was against NSP policy to confiscate medically necessary equipment, nothing in the record contradicted Officer Christy's testimony that the determination of medical necessity was left not to medical personnel, but rather to the sergeant or whoever was in charge that day. Nothing in the record suggests that this person was required, encouraged, or even permitted to refer inmates with claims of medical necessity to trained medical personnel. Again, the district court made no findings on this issue because the court simply failed to recognize or identify the specific duties comprised by the broad language of sections 209.131 and 209.161. This essentially factual issue is one for the district court to determine, at least in the first instance. 63 If Housewright's and Sumner's general policies regarding admission, by their silence or otherwise, permitted nonmedical personnel to confiscate medical equipment without obtaining any medical advice, then I submit that Housewright and Sumner must bear full responsibility for the entirely foreseeable confiscations that were virtually certain to occur. When those confiscations rise to the level of deliberate indifference, as did the one at issue here, then Housewright and Sumner must be held liable for their omissions under section 1983. However, for the same reasons as those I expressed in Part II.A, supra, I would remand to the district court for an initial determination of the constitutional soundness of admission procedures at NSP.