Opinion ID: 777261
Heading Depth: 3
Heading Rank: 8

Heading: Michigan Department of Mental Health and NRPH

Text: 45 Finally, the Michigan Department of Mental Health's role as operator of NRPH and NRPH's role as health care provider does not subject either to liability under the doctrine of respondeat superior in the absence of some evidence of a policy or custom that would subject these employers to § 1983 liability under the facts of the case now before us. Monell v. Dept. of Social Serv., 436 U.S. 658, 691, 98 S.Ct. 2018, 56 L.Ed.2d 611 (1978). Under these facts, there is no material issue of fact as to whether either of these defendants had such a policy and were therefore deliberately indifferent to the decedent's serious medical needs. 46 In light of the foregoing, plaintiff has presented sufficient evidence to establish a question of fact regarding whether one or more defendants were deliberately indifferent to the decedent's serious medical needs. The district court analyzed this case under a higher than warranted standard for deliberate indifference. The district court concluded that the individual defendants did respond to the decedent's medical needs, and that, although each defendant's individual response may not have been immediate, the district court found that plaintiff failed to advance facts to support a showing of deliberate indifference. The district court determined that defendants' responses and attempts to treat the decedent foreclosed the possibility of deliberate indifference on defendants' part. 47 The district court's analysis ignores the lower grossly inadequate care standard for finding deliberate indifference to serious medical needs. J.A. at 28 32. Under this standard, it is probable that a jury could conclude that reasonable medical professionals in Dr. Said, Dr. Lee, Dr. Sadasivan, and Nurse Owens' positions would have concluded that there was a substantial risk to the decedent's safety, and that these defendants exhibited a deliberate indifference in treating and caring for the decedent which directly led to his death. Thus, the district court's grant of summary judgment in favor of Dr. Said, Dr. Lee, Dr. Sadasivan, and Nurse Owens was erroneous. Accordingly, we remand with instructions to send the plaintiff's claims against Dr. Said, Dr. Lee, Dr. Sadasivan and Nurse Owens to trial to determine whether any of these defendants had a deliberate indifference to the decedent's serious medical needs under the grossly inadequate care standard. 48 Accordingly, under the facts of this case, we find that the conduct of Dr. Pan, Dr. Nair, Dr. Kim, Dr. Almasi, Ms. Fanning, the Michigan Department of Mental Health, and NRPH does not support a finding of deliberate indifference. Accordingly, we affirm the district court's order of summary judgment in favor of these defendants on the Eighth Amendment claim. D. Fourteenth Amendment
49 The Due Process Clause of the Fourteenth Amendment affords incarcerated individuals the right to adequate food, shelter, clothing and medical care. Youngberg v. Romeo, 457 U.S. 307, 315, 102 S.Ct. 2452, 73 L.Ed.2d 28 (1982). The involuntarily committed have greater rights regarding confinement under the Fourteenth Amendment than criminals are due under the Eighth Amendment. Persons who have been involuntarily committed are entitled to more considerate treatment in conditions of confinement than criminals whose conditions of confinement are designed to punish. Id. at 321-22, 102 S.Ct. 2452. Such persons have a claim to safe conditions inasmuch as the Supreme Court has stated that [i]f it is cruel and unusual punishment to hold convicted criminals in unsafe conditions, it must be unconstitutional to confine the involuntarily committed — who may not be punished at all — in unsafe conditions. Id. at 315-16, 102 S.Ct. 2452. The Court held that an individual may impose civil liability against professionals violating such rights: 50 when the decision by the professional is such a substantial departure from accepted professional judgment, practice or standards as to demonstrate that the person responsible actually did not base the decision on such a judgment. 51 . . . . 52 [Furthermore, under the Fourteenth Amendment,] [t]he state also has the unquestioned duty to provide reasonable safety for all residents and personnel within the institution. 53 Id. at 323-24, 102 S.Ct. 2452. 54 In the present case, Terrance asserts that each individually named defendant committed a substantial departure from accepted professional treatment. For example, Terrance argues that Dr. Said did not respond to the decedent's medical emergency in a timely fashion, and thus substantially departed from accepted professional treatment. Terrance claims that Dr. Lee substantially departed from accepted professional treatment because she increased the decedent's medication despite the decedent's dehydration, allowed the decedent to participate in outdoor activities, and failed to seek alternate assistance in light of Dr. Said's delayed response to the decedent's medical emergency. Terrance also claims that Nurse Owens made a substantial departure from accepted professional treatment because she did not equip Ward C with ice, enema equipment, and a rectal thermometer, and failed to seek alternate assistance in light of Dr. Said's untimely response to the decedent's medical emergency. Finally, Terrance argues that Dr. Almasi made a substantial departure because he did not institute policies and procedures to prevent the decedent's death. 55 The district court held that defendants' individual actions did not constitute violations of the decedent's due process rights. The lower court reasoned that Terrance failed to demonstrate that defendants treated the decedent inappropriately or did less than their training indicated was necessary. However, the district court failed to consider the heightened protection afforded to the decedent under the Fourteenth Amendment. Specifically, in its analysis, the lower court did not consider the decedent's heightened constitutional protection under Youngberg. 56 The mere fact that the decedent was involuntarily committed under proper procedures does not deprive him of all substantive liberty interests under the Fourteenth Amendment. See Vitek v. Jones, 445 U.S. 480, 494, 100 S.Ct. 1254, 63 L.Ed.2d 552 (1980) (the stigmatizing consequences of a transfer to a mental hospital for involuntary psychiatric treatment, coupled with the subjection of the prisoner to mandatory behavior modification as a treatment for mental illness, constitute the kind of deprivations of liberty that requires procedural protections). The liberty interest that one retains is not, however, absolute. Youngberg, 457 U.S. at 319-20, 102 S.Ct. 2452. 57 This issue here is governed largely by Youngberg because the facts in this case are similar in key respects to the Youngberg case. Like the decedent here, the respondent in Youngberg was involuntarily committed to a mental health facility to [obtain] reasonable care and safety, conditions not available to him outside of an institution. Id. at 321, n. 27, 102 S.Ct. 2452. The respondent brought a substantive due process claim against the institution, alleging that his constitutional right to safe conditions of confinement had been violated. The district court held that the Eighth Amendment was the proper standard for determining the rights of the involuntarily committed. Id. at 312, 102 S.Ct. 2452. The Third Circuit, sitting en banc, reversed and remanded for a new trial. Romeo v. Youngberg, 644 F.2d 147, 172 (3d Cir.1980) (en banc), vacated, 457 U.S. 307, 102 S.Ct. 2452, 73 L.Ed.2d 28 (1982). The en banc court determined that the Fourteenth Amendment and the liberty interest protected by that Amendment provide the proper constitutional basis for those rights. Id at 157. In applying the Fourteenth Amendment, the court found that the involuntarily committed retain liberty interests in freedom of movement and in personal security. Id. The court concluded that these rights are fundamental liberties that can be limited only by an overriding, non-punitive state interest. Id. at 157-58 (footnote omitted). The Supreme Court vacated the Third Circuit's decision because it concluded that the jury was erroneously instructed on the appropriate standard of liability. Youngberg, 457 U.S. at 325, 102 S.Ct. 2452. The Court stated that the appropriate question for the jury was not simply whether the decedent's liberty interest was infringed. Id. at 320, 102 S.Ct. 2452. Rather, the lower court should have charged the jury to determine whether the lack of absolute safety violated the decedent's substantive due process rights. Id. 58 In order to determine whether a substantive right protected by the Due Process Clause has been violated, it is necessary to balance `the liberty of the individual' and `the demands of an organized society.' Id. (citing Poe v. Ullman, 367 U.S. 497, 542, 81 S.Ct. 1752, 6 L.Ed.2d 989 (1961) (Harlan, J., dissenting)). In order to ascertain whether a state has adequately protected the rights of an involuntarily committed mental patient, the Constitution only requires that courts make certain that professional judgment in fact was exercised. Youngberg, 457 U.S. at 321, 102 S.Ct. 2452. In making such determinations, decisions made by the appropriate professional are entitled to a presumption of correctness unless it is established that the person responsible did not base the decision on accepted professional judgment. Id. at 323, 102 S.Ct. 2452. Throughout this analysis, courts must acknowledge that a heightened degree of protection must be afforded to the involuntarily committed. See id. at 321-22, 102 S.Ct. 2452. 59
60 Here, as in Youngberg, the respective due process interests of the decedent and NRPH should have been balanced. While NRPH has an interest in running an administratively efficient institution, such an interest should not be allowed to trump the constitutional rights of the involuntarily committed who are institutionalized for their own safety. Although the State has considerable discretion in determining the nature and scope of its responsibilities, it is also charged with adhering to professional norms of conduct. Id. at 317, 323-24, 102 S.Ct. 2452. Moreover, where hospital staff admittedly fail to follow institutional policies and procedures, questions about the State's adherence to accepted professional conduct are not unwarranted. 61 The decedent's personal safety was entrusted to NRPH and its staff. Yet, the decedent met his demise while committed to NRPH. Here, numerous questions about the decedent's safety and NRPH staff's actions abound. First, would a reasonable medical professional in this situation have allowed a mental health patient known to have heightened sensitivity to heat stroke be placed in a location with the potential for high temperatures? Additionally, would a reasonable medical professional have allowed such a patient to wander off on an extremely hot day when the patient was ordered to stay indoors? Finally, would a reasonable medical professional take an hour to respond to a medical emergency involving a patient known to have numerous serious medical conditions without any explanation for the delay? 62 These factual issues have not been clarified in this case because the district court failed to consider this case under the Fourteenth Amendment standard. 5 We decline to make such factual determinations as this is well beyond the realm of this court's authority. However, we believe that it is essential that such factual determinations are made in accord with appropriate legal standards. 63 In the instant case, the decedent was involuntarily committed. The lower court should have considered the defendants' duty to provide reasonable safety for the decedent under a heightened Fourteenth Amendment standard. Under this legal standard, there clearly was a genuine issue of material fact with regard to some of the defendants which could lead a rational fact finder to find in Terrance's favor: whether the actions and inactions of the named defendants were based upon accepted professional judgment. The facts in this case could likely support a finding that one or more defendants committed a substantial departure from accepted professional judgment. Thus, the district court's grant of summary judgment in defendants' favor was erroneous. Accordingly, we find that is necessary upon remand for the district court to conduct a trial on plaintiff's claims against each named defendant under the Fourteenth Amendment standard as outlined in this opinion as the lower court has not yet considered the decedent's due process rights under this standard.