Opinion ID: 3036756
Heading Depth: 3
Heading Rank: 2

Heading: Failure to Implement Policies

Text: In addition to a theory of municipal liability based on the County’s failure adequately to train its medical staff, Appellant asserts that the County is liable for its failure to develop and implement necessary policies including a fall policy, a transfer policy, and a policy requiring prompt medical assessment in the event that an inmate refuses an essential medical treatment such as oxygen. The County argues that the policies it had in place were constitutionally sound. Below, the district court rejected Appellant’s argument, holding that “Plaintiff’s insistence that the County should have had specific guidelines on how an MSB doctor was to treat each of [Mr. Idlet’s] symptoms, from crackles on bilateral lung fields to dark urine LONG v. COUNTY OF LOS ANGELES 3361 to swelling to incontinence, would require the County to create a policy to address every medical exigency an MSB doctor might encounter.” Long v. County of Los Angeles, No. 03-00531 DSF, Order Granting Defendant’s Motion for Summary Judgment at 9 (Feb. 10, 2004). Appellant maintains that the district court’s reasoning does not accurately address her argument, which is that the policy deficiency was not a failure to instruct on each specific medical symptom, but a failure to have adequate general policies. [10] This court consistently has found that a county’s lack of affirmative policies or procedures to guide employees can amount to deliberate indifference, even when the county has other general policies in place. For example, in Gibson, a mentally ill detainee died while in the custody of the county jail. The decedent’s wife sued the county, alleging that it had acted with deliberate indifference to her husband’s mental illness. The district court granted summary judgment in favor of the county. On appeal, this court reversed and remanded, finding that the county’s policy—which precluded a medical evaluation for an incoming detainee who was uncooperative, combative, or intoxicated—failed adequately to instruct the nurse on duty how to act upon medical information, including information from prescription medications, which she obtained from the detainee. The court held that a jury could find that the omission was sufficiently likely to result in the violation of the detainee’s right to medical care that the county was deliberately indifferent to those needs. 290 F.3d at 1195. “When policymakers know that their medical staff members will encounter those with urgent mental health needs yet fail to provide for the identification of those needs, it is obvious that a constitutional violation could well result.” Id. at 1196. In Fairley, an arrestee who had been held in jail for twelve days as the result of a mistaken identification sued the City of Long Beach for the violation of his constitutional rights. At trial the jury found the city liable. On appeal this court 3362 LONG v. COUNTY OF LOS ANGELES affirmed, finding that even though the city’s policies and procedures had been complied with fully, the plaintiff had presented sufficient evidence to establish that the city’s failure to instigate procedures to alleviate the problem of detaining individuals on the wrong warrant could constitute a policy of deliberate indifference. 281 F.3d at 918. And in Oviatt, this court held that even though the county had a system for tracking arraignment dates for detainees, its lack of procedures to alleviate the problem of detecting missed arraignments—which resulted in the plaintiff’s prolonged detention without an arraignment, a bail hearing, or a trial—was a policy of inaction that amounted to deliberate indifference to pretrial detainees’ constitutional rights. 954 F.2d at 1478. In the present case, Appellant’s experts have opined that the County lacked adequate policies requiring MSB medical staff to transfer patients in the event of signs of medical instability, and to notify a physician promptly when an inmate falls, and when an inmate refuses essential medical treatment, such as when Mr. Idlet refused oxygen. The experts conclude that these inadequacies reflected deliberate indifference to Mr. Idlet’s medical care and resulted in his death. In rebuttal, the County provides testimony of its expert doctors and the MSB nurses, as well as relevant portions of the medical record, to show that Mr. Idlet was seen by nurses numerous times while he was in the MSB and that the staff afforded him proper care. The County asserts that the alleged instances of the MSB medical staff’s neglect were isolated occurrences that do not reflect deliberate indifference and cannot be the basis for municipal liability. [11] We conclude that Appellant has presented evidence that creates a triable issue regarding whether the County’s failure to implement a policy for responding to the fall of a medically unstable patient, a policy providing for prompt medical assessment if an MSB patient refuses necessary treatLONG v. COUNTY OF LOS ANGELES 3363 ment, and a transfer policy, directing MSB staff immediately to transfer patients no longer medically stable, amounted to deliberate indifference to Mr. Idlet’s constitutional rights.