Opinion ID: 883122
Heading Depth: 1
Heading Rank: 6

Heading: Did the District Court err in directing a verdict on Buhr's civil rights claims against Flathead County and Rhodes for their denial of medical treatment under the deliberate indifference standard?

Text: Buhr also argues that the District Court improperly applied the deliberate indifference standard. He contends that the evidence established that Flathead County and Rhodes were deliberately indifferent to Joshua's constitutional rights in terms of the medical treatment Joshua received; on that basis, he urges that the trial court erred in directing a verdict on his civil rights claims related to that medical treatment. Buhr first addresses the District Court's grant of Flathead County's motion for a directed verdict on the civil rights claims regarding Joshua's medical treatment while detained in the soft cell. He argues that the detention center's hands-off policy toward mental health detainees, abbreviated booking procedures, and the fact that detention center personnel's only medical background consisted of first-aid training, prevented detention center personnel from adequately monitoring Joshua's medical needs and providing him the medical treatment he required. Relying on the Supreme Court's decision in Youngberg, Buhr contends in this regard that Flathead County was required to ensure that decisions regarding Joshua's medical care were made by medical professionals exercising professional judgment. Under this standard, liability could be imposed for decisions regarding medical treatment when the decision [regarding medical treatment] ... 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. Youngberg, 457 U.S. at 323, 102 S.Ct. at 2462. Buhr argues that Flathead County's policies regarding medical treatment of detainees held under § 53-21-129, MCA, prevented qualified medical professionals from making determinations regarding Joshua's medical treatment and exhibited deliberate indifference to Joshua's medical needs. In large part, this argument is an attempt to weave the Youngberg professional judgment standard advocated above into the deliberate indifference standard which is properly before us. We reject such an approach. Buhr brought his civil rights claims pursuant to 42 U.S.C. § 1983, which states in pertinent part: Every person who, under color of any statute, ordinance, regulation, custom, or usage, of any State ... subjects, or causes to be subjected, any citizen of the United States or other person within the jurisdiction thereof to the deprivation of any rights, privileges, or immunities secured by the Constitution and laws, shall be liable to the party injured in an action at law, suit in equity, or other proper proceeding for redress.... Liability cannot be imposed on a local government entity for a constitutional tort pursuant to 42 U.S.C. § 1983 unless a plaintiff establishes: (1) that he possessed a constitutional right of which he was deprived; (2) that the municipality had a policy; (3) that this policy amounts to deliberate indifference to the plaintiff's constitutional right; and (4) that the policy is the moving force behind the constitutional violation. Oviatt By and Through Waugh v. Pearce (9th Cir.1992), 954 F.2d 1470, 1474. A district court may grant a directed verdict only when it appears as a matter of law that the nonmoving party could not recover upon any view of the evidence, including the legitimate inferences to be drawn from the evidence. King v. Zimmerman (1994), ___ Mont. ___, ___ _ ___, 878 P.2d 895, 899, 51 St.Rep. 659, 660-61 (citation omitted). A motion for a directed verdict should only be granted when there is a complete absence of any evidence to warrant submission [of the case] to the jury and all factual inferences must be viewed in the light most favorable to the nonmoving party. Moralli v. Lake County (1992), 255 Mont. 23, 27, 839 P.2d 1287, 1289. We review a district court's decision regarding a motion for a directed verdict to determine if the court abused its discretion. See Nelson v. Flathead Valley Transit (1992), 251 Mont. 269, 274, 824 P.2d 263, 267. Buhr was required to offer evidence on each of the four elements necessary to impose liability pursuant to 42 U.S.C. § 1983, in order to withstand a motion for a directed verdict. We focus on the second and third elements. Under Pearce, the second element of Buhr's § 1983 action against Flathead County is the existence of a county policy regarding medical treatment for individuals detained in the detention center. Buhr introduced evidence regarding the detention center's medical policies for mental health detainees. His evidence confirmed that the detention center admitted mental health detainees such as Joshua under an abbreviated booking procedure which did not mandate questions related to medications and that asking questions about medications was within the discretion of detention center personnel, who dispensed medications only when necessary for the physical health of the detainee. After a detainee was admitted, the detention center followed a hands-off policy whereby no one would enter the soft cell. Regarding medical treatment, Buhr's evidence confirmed that detention center personnel, who were trained in first-aid, were authorized to arrange either visits with doctors to provide medical treatment for detainees or, in instances where they determined a medical problem was more serious, transportation of the detainee to the hospital. The record, therefore, is clear that Buhr offered evidence on the second element. Buhr's evidence regarding existence of a policy, however, is insufficient to trigger liability for Flathead County and Rhodes under 42 U.S.C. § 1983, or to withstand a motion for a directed verdict. See Pearce, 954 F.2d at 1477. A plaintiff such as Buhr must also offer evidence on the third element and that evidence, or legitimate inferences therefrom, must be sufficient to allow him to recover on the claim that the county's policy exhibited a deliberate indifference to Joshua's constitutional rights. Pearce, 954 F.2d at 1477. This occurs when the need for more or different action `is so obvious, and the inadequacy [of the current procedure] so likely to result in the violation of constitutional rights, that the policy makers ... can reasonably be said to have been deliberately indifferent to the need.' Pearce, 954 F.2d at 1477-78; citing City of Canton v. Harris (1989), 489 U.S. 378, 390, 109 S.Ct. 1197, 1205, 103 L.Ed.2d 412, 427. City of Canton involved a claimant, Harris, who was brought to a police station in an incoherent state and, after being taken inside, slumped to the floor where the police allowed her to remain without any medical attention. One hour later, Harris was released and taken to a hospital via an ambulance provided by her family. She was diagnosed with severe emotional ailments and hospitalized. City of Canton, 489 U.S. at 381, 109 S.Ct. at 1201. Harris subsequently brought an action pursuant to 42 U.S.C. § 1983, claiming the city was liable for violation of her right to receive necessary medical attention while in police custody. Harris claimed that Canton provided police shift commanders sole discretion, without any special training beyond first-aid, to determine when to summon medical care for an injured detainee. City of Canton, 489 U.S. at 381-82, 109 S.Ct. at 1201. Her case went to the jury under a reckless, intentional or with gross negligence standard and the jury found in her favor. On appeal, the Sixth Circuit Court of Appeals affirmed the imposition of municipal liability under § 1983 where a plaintiff proves that a municipality, acting recklessly, intentionally or with gross negligence, failed to train its police force, and where that failure resulted in a deprivation of constitutional rights that was substantially likely to result. City of Canton, 489 U.S. at 385, 109 S.Ct. at 1203. The United States Supreme Court rejected the Circuit Court's overly broad rule for imposing a municipal liability under § 1983 and adopted the deliberate indifference standard. City of Canton, 489 U.S. at 388, 109 S.Ct. at 1204. It determined that only where a failure to train reflects a `deliberate' or `conscious' choice by a municipality ... can a city be liable for such a failure under § 1983. City of Canton, 489 U.S. at 389, 109 S.Ct. at 1205. The focus of the inquiry must be on the adequacy of the training program in relation to the tasks the particular officers must perform. City of Canton, 489 U.S. at 390, 109 S.Ct. at 1205. The Court then stated: [n]either will it suffice to prove that an injury or accident could have been avoided if an officer had had better or more training, sufficient to equip him to avoid the particular injury-causing conduct. Such a claim could be made about almost any encounter resulting in injury, yet not condemn the adequacy of the program to enable officers to respond properly to the usual and recurring situations with which they must deal. City of Canton, 489 U.S. at 391, 109 S.Ct. at 1206 (emphasis added). Following the City of Canton, the Ninth Circuit Court of Appeals addressed the question of when a policy exhibits deliberate indifference in Pearce. In Pearce, an arrestee who remained incarcerated for 114 days before being arraigned, sued the county and the sheriff alleging violations under § 1983. Pearce, 954 F.2d at 1472. The arrestee's name was dropped from the booking sheet through an error by the court clerk who prepared the docket sheet. Pearce, 954 F.2d at 1473. While the sheriff was aware that inmates were not arraigned because of mistakes similar to this, the sheriff's department failed to develop internal procedures to guard against mistakes and chose to rely on the inmates, their attorneys, or family members. Pearce, 954 F.2d at 1473. The evidence demonstrated, however, that some inmates were unable to communicate with their lawyers or family members and that the sheriff knew of nineteen incidents where inmates missed arraignments due to mistakes by jail and court personnel. Pearce, 954 F.2d at 1478. The federal district court refused defendant county's and sheriff's motion for judgment notwithstanding the verdict and defendants appealed. The Ninth Circuit determined that it was reasonably certain, given the lack of procedures to relieve the known problem, that inmates would be erroneously deprived of their liberty and that the need for different procedures was so obvious that the sheriff's refusal to institute procedures to guard against known and repeated mistakes amounted to deliberate indifference. Pearce, 954 F.2d at 1478. Here, the District Court concluded that Buhr's evidence regarding Flathead County's medical policies was insufficient to go to the jury under the deliberate indifference standard. Buhr's evidence established that Joshua was visually monitored every five to fifteen minutes and physically observed every fifteen to thirty minutes while he was detained in the soft cell. He further established that the detention personnel, had they detected a medical emergency, would not have hesitated to summon medical help for Joshua. Unlike the situation in Pearce, Buhr's evidence did not establish  or tend to establish by inference  any awareness by Rhodes or detention center personnel that existing medical policies regarding mental health detainees were causing or likely to cause denial of adequate medical treatment to such detainees. Indeed, Harris testified during Buhr's case in chief that the hands-off policy is the preferred approach in dealing with violently mentally ill detainees placed in a soft cell. In his view, having people enter the soft cell might further the detainee's agitation or combativeness and the preferred treatment is to try not to do so. Furthermore, there is a complete absence of evidence under the City of Canton guidelines demonstrating that the detention center's need for different medical procedures was so obvious, and the procedures so deficient when compared to the usual medical situation confronting detention personnel, that Flathead County and Rhodes were deliberately indifferent to that need. Buhr's failure to offer evidence which would be sufficient to allow him to recover under the deliberate indifference standard defeats his § 1983 claim regarding inadequate medical treatment. Thus, the District Court did not abuse its discretion in directing a verdict on the civil rights claims relating to lack of medical treatment for Joshua under that standard.