Opinion ID: 173410
Heading Depth: 2
Heading Rank: 3

Heading: Qualified ImmunityDr. Wagner, Ms. Cunningham, and Mr. Anderson

Text: Finally, we address the Jensens' constitutional claims against Dr. Wagner, Ms. Cunningham, and Mr. Anderson, who have all claimed a defense of qualified immunity. When a defendant pleads qualified immunity, the plaintiff has the heavy burden of establishing: (1) that the defendant's actions violated a federal constitutional or statutory right; and (2) that the right violated was clearly established at the time of the defendant's actions. Scott, 216 F.3d at 910 (quotations omitted). Federal courts may exercise their sound discretion in deciding which of the two prongs of the qualified immunity analysis should be addressed first in light of the circumstances in the particular case at hand. Pearson v. Callahan, ___ U.S. ___, 129 S.Ct. 808, 818, 172 L.Ed.2d 565 (2009). The clearly established prong of the qualified immunity analysis ensures that governmental actors are given fair warning that their conduct is unconstitutional before they are held liable for damages based on that conduct. Harman v. Pollock, 586 F.3d 1254, 1260 (10th Cir.2009). A right is clearly established when a Supreme Court or Tenth Circuit decision is on point, or if the clearly established weight of authority from other courts shows that the right must be as [the] plaintiff maintains. Id. at 1261. That does not mean that we must have previously decided a case that is materially factually similar or identical to the present case; instead, [t]he contours of the right must be sufficiently clear that a reasonable official would understand that what he is doing violates that right. Anderson v. Creighton, 483 U.S. 635, 640, 107 S.Ct. 3034, 97 L.Ed.2d 523 (1987).
The district court concluded that the Jensens failed to show that any defendant violated their right to direct P.J.'s medical care. Because the district court decided this issue under the first prong of the qualified immunity analysis, it did not have occasion to consider whether the Jensens' right to direct P.J.'s medical care in the circumstances presented in this case was clearly established at the time of the alleged violations. Furthermore, on appeal, the Jensens confine their argument to the first prong of the qualified immunity analysis and assume that under the circumstances of this case their right to direct P.J.'s medical care is clearly established. We reject this assumption and conclude that the Jensens' right to direct P.J.'s medical care in this caseif any right indeed exists in such circumstanceswas not clearly established at the time the Jensens allege the right was violated. We begin by acknowledging that the Due Process Clause generally provides constitutional protection for parental rights. Indeed, the Supreme Court has stated that the Due Process Clause of the Fourteenth Amendment protects the fundamental right of parents to make decisions concerning the care, custody, and control of their children. Troxel v. Granville, 530 U.S. 57, 66, 120 S.Ct. 2054, 147 L.Ed.2d 49 (2000). Furthermore, although we have never specifically recognized or defined the scope of a parent's right to direct her child's medical care, see Roska v. Peterson, 328 F.3d 1230, 1247 n. 14 (10th Cir.2003) (We express no opinion on whether such a right [to direct a child's medical care] might exist within the context of general familial rights.), we do not doubt that a parent's general right to make decisions concerning the care of her child includes, to some extent, a more specific right to make decisions about the child's medical care. See Dubbs v. Head Start, Inc., 336 F.3d 1194, 1203 (10th Cir. 2003) (It is not implausible to think that rights invoked herethe right to refuse a medical exam and the parent's right to control the upbringing, including the medical care, of a childfall within [the Due Process Clause's] sphere of protected liberty.). The Supreme Court has similarly alluded to, but never specifically defined the scope of a parent's right to direct her child's medical care. Indeed, the Court has recognized that [m]ost children, even in adolescence, simply are not able to make sound judgments concerning ... their need for medical care or treatment, Parham v. J.R., 442 U.S. 584, 603, 99 S.Ct. 2493, 61 L.Ed.2d 101 (1979), and that our legal system presumes that natural bonds of affection lead parents to act in the best interests of their children. Id. at 602., 99 S.Ct. 2493 Therefore, this precedent reasonably suggests that the Due Process Clause provides some level of protection for parents' decisions regarding their children's medical care. The Supreme Court has long recognized, however, that parental rights, including any right to direct a child's medical care, are not absolute. See Prince v. Massachusetts, 321 U.S. 158, 166, 64 S.Ct. 438, 88 L.Ed. 645 (1944) ([N]either rights of religion nor rights of parenthood are beyond limitation.); see also Parham, 442 U.S. at 604, 99 S.Ct. 2493 ([P]arents cannot always have absolute and unreviewable discretion to decide whether to [seek specific medical care for their children], but they retain plenary authority to seek such care for their children, subject to a physician's independent examination and medical judgment.). Indeed, states have a compelling interest in and a solemn duty to protect the lives and health of the children within their borders. See, e.g., Globe Newspaper Co. v. Superior Court for Norfolk County, 457 U.S. 596, 607, 102 S.Ct. 2613, 73 L.Ed.2d 248 (1982) ([S]afeguarding the physical and psychological well-being of a minor ... is a compelling [interest].). Accordingly, when a child's life or health is endangered by her parents' decisions, in some circumstances a state may intervene without violating the parents' constitutional rights. See Parham, 442 U.S. at 603, 99 S.Ct. 2493 ([W]e have recognized that a state is not without constitutional control over parental discretion in dealing with children when their physical or mental health is jeopardized.). Under this constitutional framework, we conclude that the Jensens' asserted right to direct P.J.'s medical care in this case is not clearly established. The record demonstrates that no less than seven qualified and competent doctors evaluated P.J., diagnosed him with life-threatening cancer, and recommended that he immediately undergo chemotherapy treatment in order to save his life. In this particular situation, the Jensens did not have a clearly established constitutional right to refuse the unanimous recommended treatment or to solicit additional opinions until they found a doctor who disagreed that conventional treatment was necessary. Indeed, the Jensens had a `high duty' to recognize symptoms of illness and to seek and follow medical advice. Id. at 602., 99 S.Ct. 2493 Furthermore, when a child's life is under immediate threat, a state's interest in protecting the child is at its zenith, and a state has broad authority to intervene in parental decisionmaking that produces the threat to the child's life. See Prince, 321 U.S. at 167, 64 S.Ct. 438 ([T]he state has a wide range of power for limiting parental freedom and authority in things affecting the child's welfare.). Here, the state was endowed with this broad authority, and the Jensens do not direct us to a clearly established constitutional line that defines what a state can and cannot do to protect a child whose life is compromised by his parents' refusal to obtain medical care. Certainly, the Jensens do not assert any factual allegation that is substantially supported in the record which would constitute state action that is clearly outside the state's wide range of power. Accordingly, under the circumstances of this case, the Jensens' asserted right to direct P.J.'s medical care was not clearly established at the time of the alleged violations; therefore, they cannot overcome the defendants' claims of qualified immunity.
In contrast to the Jensens' purported right to direct P.J.'s medical care in this case, we resolve their claims regarding their substantive due process right to familial association and their procedural due process rights on the first prong of the qualified immunity inquirynamely, that the Jensens have not shown a violation of their constitutional rights. More than twenty-five years ago the Supreme Court recognized that [f]amily relationships, by their nature, involve deep attachments and commitments to the necessarily few other individuals with whom one shares not only a special community of thoughts, experiences, and beliefs but also distinctively personal aspects of one's life. Roberts v. U.S. Jaycees, 468 U.S. 609, 619-620, 104 S.Ct. 3244, 82 L.Ed.2d 462 (1984). Shortly thereafter, this court first recognized the existence of a right to familial association within the substantive rights protected by the Due Process Clause. See Griffin v. Strong, 983 F.2d 1544, 1546-47 (10th Cir.1993) (discussing the development of the right of familial association in the Tenth Circuit). In numerous decisions since the right was first recognized, we have applied a balancing test to determine whether the plaintiff's right to familial association has been infringed. See, e.g., id. at 1547-49; J.B. v. Washington County, 127 F.3d 919, 927 (10th Cir.1997); Lowery v. County of Riley, 522 F.3d 1086, 1092 (10th Cir.2008). Under this test, we balance `the individual's interest in liberty against the State's asserted reasons for restraining individual liberty.' Lowery, 522 F.3d at 1092 (quoting Youngberg v. Romeo, 457 U.S. 307, 320, 102 S.Ct. 2452, 73 L.Ed.2d 28 (1982)). The purpose of the balancing test is to ascertain whether a defendant's conduct constitutes an undue burden on the plaintiff's associational rights. Griffin, 983 F.2d at 1547. Because the Jensens' opening brief fails to articulate a particularized factual allegation that any defendant violated their associational rights, we address their general claims under the balancing test discussed above. First, the Jensens' interest in associating with P.J. is unquestionably of paramount importance. See id. at 1548 (The right to associate with one's family is a very substantial right.); see also U.S. Jaycees, 468 U.S. at 618, 104 S.Ct. 3244 ([F]reedom of association receives protection as a fundamental element of personal liberty.). Second, as discussed above, the state's interest in protecting and safeguarding P.J.'s life is also significant. Finally, given these countervailing interests, the record demonstrates that the actual burden on the Jensens' right to associate with P.J. was minimal in this case. The Jensens correctly point out that the forced separation of parent from child, even for a short time, represents a serious impingement. J.B., 127 F.3d at 925 (alteration omitted). In this case, however, P.J. was never physically removed from the Jensens' custody and the state afforded the Jensens numerous opportunities to obtain treatment for P.J. before it even sought to remove him from their custody. Under these circumstances, the Jensens fail to show that any defendant imposed an undue burden on their relationship with P.J. and therefore fail to show a violation of their associational rights.
[P]rocedural due process does not prevent the state from depriving an individual of liberty or property. It only requires that a fair procedure be provided for the deprivation. Doyle v. Okla. Bar Ass'n, 998 F.2d 1559, 1569 (10th Cir.1993). As a threshold matter, a plaintiff must show that he possesses a constitutionally cognizable liberty or property interest before he can allege an unconstitutional deprivation of that interest. Id. To be constitutionally cognizable, the interest must rise to more than an abstract need or desire and must be based on more than a unilateral hope. Ky. Dep't of Corr. v. Thompson, 490 U.S. 454, 460, 109 S.Ct. 1904, 104 L.Ed.2d 506 (1989) (internal quotations and citations omitted). Indeed, to satisfy the threshold requirement, a plaintiff must demonstrate a legitimate claim of entitlement to the asserted interest which may arise either from the Due Process Clause itself or state law. Id. `A state creates a protected liberty interest by placing substantive limitations on official discretion.' Doyle, 998 F.2d at 1569 (quoting Olim v. Wakinekona, 461 U.S. 238, 249, 103 S.Ct. 1741, 75 L.Ed.2d 813 (1983)) (alteration omitted). State law, however, does not generally create a constitutionally cognizable liberty interest simply by establishing substantive predicates to govern official decision-making; rather, the state must also mandat[e] the outcome to be reached upon a finding that the relevant criteria have been met. Thompson, 490 U.S. at 462, 109 S.Ct. 1904 (quotations and citations omitted). If state law establishes a substantive predicate without mandating an outcome, the law creates nothing more than a right to process which is not a constitutionally cognizable liberty interest. See Doyle, 998 F.2d at 1570 (The mere expectation of receiving a state afforded process does not itself create an independent liberty interest protected by the Due Process Clause.). Once a procedural due process plaintiff establishes a constitutionally cognizable liberty or property interest of which she has been deprived by the state, we examine[] whether the procedures attendant upon that deprivation were constitutionally sufficient. Thompson, 490 U.S. at 460, 109 S.Ct. 1904. Although the exact procedures required by the Constitution depend on the circumstances of a given case, [t]he fundamental requirement of due process is the opportunity to be heard at a meaningful time and in a meaningful manner. Mathews v. Eldridge, 424 U.S. 319, 333, 96 S.Ct. 893, 47 L.Ed.2d 18 (1976) (internal quotations omitted). The Jensens allege procedural due process claims only against Dr. Wagner and Ms. Cunningham. [4] They base their claim against Dr. Wagner on misrepresentations he allegedly made to the juvenile court and to others involved with the custody dispute. The Jensens appear to argue that these misrepresentations infected the juvenile proceedings to the point that they did not afford the Jensens the opportunity to be heard in a meaningful manner. Although we can conceive of circumstances in which false testimony may infect a judicial proceeding to the point that the proceeding itself becomes constitutionally deficient, Cf. United States v. Vaziri, 164 F.3d 556, 563 (10th Cir.1999) (concluding that a criminal conviction obtained by perjured testimony violates due process under certain circumstances), the Jensens have not demonstrated that any statements by Dr. Wagner had such a degenerative effect on the juvenile court proceedings in this case. Accordingly, the Jensens have not met their burden of showing that Dr. Wagner violated their procedural due process rights. The Jensens base their procedural due process claim against Ms. Cunningham on her failure to independently investigate the medical neglect allegations made by Dr. Wagner before filing the verified petition in the juvenile court. Specifically, the Jensens argue that Utah statutes required Ms. Cunningham to interview the Jensens and obtain an independent medical examination of P.J. before filing the verified petition. Thus, the Jensens claim a constitutionally cognizable liberty interest in an independent investigation by DCFS. As discussed above, however, a right to process under state law is not itself a liberty interest protected by the Due Process Clause; rather, state law must also mandate a specific outcome upon a finding that certain criteria are met. Doyle, 998 F.2d at 1570. The Jensens do not point to any Utah statutes that mandate a specific outcome upon completion of the required DCFS investigation and a finding that certain criteria are met during that investigation. Accordingly, the Jensens fail to establish any constitutionally cognizable liberty interest and thus fail to meet the threshold requirement for a procedural due process claim against Ms. Cunningham.