Opinion ID: 1790468
Heading Depth: 1
Heading Rank: 1

Heading: Earnell McIntosh-Wilson

Text: In deference to the exercise of discretion required of mental health care professionals, Youngberg held that the discretionary acts and decisions of such professionals will provide a ground of liability only when the decision ... 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. Id. at 323, 102 S.Ct. at 2462. Deliberate indifference thus forms the relevant standard of culpability with regard to whether constitutional rights were violated in this case. The administrator of a mental health care institution may incur supervisory liability under § 1983 for a constitutional deprivation where the policies of the Hospital as formulated or applied result in such a lack of training and supervision as to constitute deliberate indifference to clearly established constitutional rights to a reasonably safe environment. Such indifference constitutes a personal involvement in the alleged violation. See Williams v. Smith, 781 F.2d 319, 323 (2d Cir. 1986); McKinnon v. Patterson, 568 F.2d 930, 936 (2d Cir.1977), cert. denied, 434 U.S. 1087, 98 S.Ct. 1282, 55 L.Ed.2d 792 (1978); see also City of Canton v. Harris, 489 U.S. 378, 109 S.Ct. 1197, 103 L.Ed.2d 412 (1989) (municipal liability depends on whether there is a direct causal link between a municipal policy or custom, and the alleged constitutional deprivation). In other words, policy-making administrators would be liable for the constitutional deprivations caused by their subordinates if they exhibited such a degree of indifference to compliance with their policies as to demonstrate that they did not base their actual administrative decisions or actions on the professional judgments embodied in the policy. Cf. Youngberg, 457 U.S. at 323, 102 S.Ct. at 2462; City of Canton, 489 U.S. at 390, 109 S.Ct. at 1205 (through indifference, a municipality could actually have a policy of not taking reasonable steps to train its employees). As chief executive officer, Mrs. McIntosh-Wilson formulated policies and procedures for the administration of the Hospital, including individual habilitation plans. Her duties included quality control, that is, responsibility for implementing procedures to ensure compliance with formulated policy. In opposition to the motions for summary judgment, Rose George submitted the affidavit of her expert, who faulted the policies and procedures in the following respects: I see no evidence of on-going communication between the administration, psychiatric staff and direct care staff as related to Andre Alex George; in fact, the mental health worker on duty at the time of the incident testified that she did not know if a Behavioral Management Plan was in effect for Andre Alex George. The records that I have reviewed indicate a long and substantial history of maladaptive behavior on the part of Andre Alex George in regard to the mouthing of his hands and objects. That the administrative defendants failed to insure that this information would be adequately disseminated to the direct care staff is a departure from professional standards that in my opinion are absolutely necessary for the maintenance of a safe environment. .... Assuming that policies existed at the time of the incident to impart information to subordinates and direct care employees regarding the provision and maintenance of a reasonably safe environment for the care of Andre Alex George, I see no evidence that this in fact occurred. The fact that the direct care employee left Andre Alex George alone in the bathroom for an extended period of time relative to his mental condition and needs is a strong indication that the policies or customs of the ... Hospital regarding patient safety were below the standard of care as implemented and maintained. (Emphasis added.) Rose George's expert found evidence of faulty communication at the administrative level. Indeed, the record indicates that Barbara Jackson received only 10 minutes of formal instruction on Andre George's behavior and habilitation plans at the time of her assignment to his care. Moreover, Jackson testified that no one had ever discussed George's mouthing habit with her. The question whether, notwithstanding documentary evidence of administrative cognizance of George's needs, Hospital policies were more illusory than real presents a factual issue that precludes summary judgment. Rose George should have been given further opportunity to prove her allegations regarding this defendant's exercise of judgment and the possible existence of a mere paper policy.