Court Opinion

ID: 9960171
Source: CourtListenerOpinion
Date Created: 2024-04-15 17:01:00.782347+00
Date Added: 2024-06-11T08:19:17.877909
License: Public Domain

FOR PUBLICATION

   UNITED STATES COURT OF APPEALS
        FOR THE NINTH CIRCUIT

ANTHONY PEREZ; CECILIA                    No. 22-15546
PEREZ; TERRALEE PEREZ,
individually and as successor in            D.C. No.
interest to Joseph Perez; JOSEPH         1:18-cv-00127-
PEREZ, Jr., individually and as            AWI-EPG
successor in interest to Joseph Perez;
MICHELLE PEREZ, individually and
as successor in interest to Joseph          OPINION
Perez,

              Plaintiffs-Appellants,
  v.

CITY OF FRESNO; COUNTY OF
FRESNO; JAMES ROSSETTI; SEAN
CALVERT; CHRIS MARTINEZ;
BRAITHAN STOLTENBERG;
ROBERT MCEWEN; KARLSON
MANASAN; JIMMY ROBNETT;
AMERICAN AMBULANCE;
MORGAN ANDERSON,

              Defendants-Appellees.

       Appeal from the United States District Court
          for the Eastern District of California
       Anthony W. Ishii, District Judge, Presiding
2                     PEREZ V. CITY OF FRESNO

          Argued and Submitted September 11, 2023
                  San Francisco, California

                       Filed April 15, 2024

Before: Danny J. Boggs, * Sidney R. Thomas, and Danielle
               J. Forrest, Circuit Judges.

                  Opinion by Judge Forrest;
     Partial Concurrence and Partial Dissent by Judge S.R.
                           Thomas

                          SUMMARY **

       Civil Rights/Deadly Force/Qualified Immunity

    The panel affirmed the district court’s summary
judgment for the City and County of Fresno, individual law-
enforcement officers, and a paramedic in an action brought
by the family of Joseph Perez, who asphyxiated and died
after the officers, at the direction of the paramedic, used their
body weight to restrain Perez while he was prone in order to
strap him to a backboard for hospital transport.
    The panel held that the law-enforcement officers were
entitled to qualified immunity. At the time of Perez’s death
in 2017, the law did not clearly establish, nor was it

*
 The Honorable Danny J. Boggs, United States Circuit Judge for the U.S.
Court of Appeals for the Sixth Circuit, sitting by designation.
**
  This summary constitutes no part of the opinion of the court. It has
been prepared by court staff for the convenience of the reader.
                   PEREZ V. CITY OF FRESNO                  3

otherwise obvious, that the officers’ actions—pressing on a
backboard on top of a prone individual being restrained for
medical transport, at the direction of a paramedic working to
provide medical care—would be unconstitutional.
    The panel next held that the paramedic involved was
entitled to qualified immunity because the law did not
clearly establish at the time that a paramedic acting in a
medical capacity to restrain a person in order to secure the
person for medical transport could be held liable for a
constitutional violation under either the Fourth or Fourteenth
Amendment.
    Finally, the panel held that the district court properly
dismissed plaintiffs’ Monell claims because plaintiffs
presented insufficient evidence that the City and the County
were deliberately indifferent to their duty to properly train
their law-enforcement officers.
    Concurring in part and dissenting in part, Judge S.R.
Thomas concurred in the majority’s analysis of the
paramedic liability and failure-to-train claims. However, he
disagreed with the conclusion that the law governing the
conduct of the individual law-enforcement defendants was
not clearly established in 2017. Extensive federal case law,
departmental guidance, and common sense gave the officers
fair warning that applying continuous force to the back of a
prone person who claims he cannot breathe is
constitutionally excessive.
4                 PEREZ V. CITY OF FRESNO

                       COUNSEL

Thomas C. Seabaugh (argued), The Law Office of Thomas
C. Seabaugh, Los Angeles, California; John C. Taylor and
Neil K. Gehlawat, Taylor & Ring LLP, Manhattan Beach,
California; David M. Shapiro, Roderick and Solange
MacArthur Justice Center, Northwestern Pritzker School of
Law, Chicago, Illinois; Easha Anand, Roderick & Solange
MacArthur Justice Center, San Francisco, California; for
Plaintiffs-Appellants.
James D. Weakley (argued) and Brande L. Gustafson,
Weakley & Arendt PC, Fresno, California; for Defendants-
Appellees County of Fresno, Robert McEwen, Karlson
Mansan, Jimmy Robnett, and Braithan Stoltenberg.
Steven J. Renick (argued), Mildred K. O' Linn, Scott W.
Davenport, and Lynn Carpenter; Manning & Kass Ellrod
Ramirez Trester LLP, Los Angeles, California; for
Defendants-Appellees City of Fresno, Officer James
Rossetti, Officer Sean Calvert, and Officer Chris Martinez.
Justin R. Sarno (argued), DLA Piper US LLP, Los Angeles,
California; Madeline A. Cordray, DLA Piper US LLP,
Phoenix., Arizona; Richard J. Ryan, R.J. Ryan Law APC,
Glendale, California; Aaron J. Weissman, Tyson & Mendes
LLP, Los Angeles, California; for Defendants-Appellees
American Ambulance and Morgan Anderson.
                    PEREZ V. CITY OF FRESNO                  5

                         OPINION

FORREST, Circuit Judge:

    In 2017, at the direction of a paramedic, law-
enforcement officers used their body weight to hold down
and restrain Joseph Perez while he was prone in order to
strap him to a backboard so he could be transported to a
hospital for mental-health treatment. Perez asphyxiated and
died. Plaintiffs—Perez’s surviving family members—appeal
the district court’s grant of summary judgment on various 42
U.S.C. § 1983 claims in favor of the City of Fresno (the
City), which oversees the Fresno Police Department (FPD);
the County of Fresno (the County), which oversees the
Fresno County Sheriff’s Office (FCSO); a number of FPD
and FCSO law-enforcement officers (collectively, the
officers); and an American Ambulance paramedic. Plaintiffs
contend that the officers and paramedic are not entitled to
qualified immunity and that the City and the County are
liable for failing to properly train their law-enforcement
officers.
    We affirm the district court. At the time of Perez’s death,
the law did not clearly establish, nor was it otherwise
obvious, that the officers’ actions, directed by medical
personnel, would violate Perez’s constitutional rights.
Likewise, the paramedic involved was acting in a medical
capacity during the incident, and the law did not clearly
establish that medical personnel are liable for constitutional
torts for actions taken to provide medical care or medical
transport. Thus, the officers and the paramedic are entitled
to qualified immunity. We also conclude that Plaintiffs
produced insufficient evidence to support their municipal-
6                  PEREZ V. CITY OF FRESNO

liability claim against the City and the County based on a
failure-to-train theory.
                     I. BACKGROUND
    In May 2017, FCSO received a call for assistance
regarding a man—later identified as Perez—who was acting
erratically, sprinting through the street, screaming, and
hiding in bushes. Before FCSO could respond to the call,
three FPD officers encountered Perez without being
dispatched. The FPD officers observed Perez standing in the
roadway, waving his arms, and yelling what sounded like
“help” in their direction. When the officers approached
Perez, he was talking to himself, stating that people were
chasing and hitting him. Based on Perez’s behavior, the
officers believed that he was under the influence of a
controlled substance. According to the officers, to prevent
Perez from darting into traffic on the four-lane roadway or
charging at the officers near the roadway, they seated Perez
on the curb and placed him in handcuffs. When the
dispatched FCSO deputies arrived, they found Perez seated,
handcuffed, and surrounded by the FPD officers.
    Five minutes after encountering Perez, one of the FPD
officers called emergency medical services (EMS) to
facilitate an involuntary psychiatric detention under
California Welf. & Inst. Code § 5150. Initially, the officer
requested a “code two” because he believed that Perez was
a danger to himself and others. A minute and a half later, the
officer elevated the request to a “code three.” The ambulance
took approximately 14 minutes to arrive on scene because it
was originally sent to the wrong location.
     While awaiting the ambulance, Perez stood up from the
curb and refused to comply with the officers’ instructions to
sit back down. In response, several of the officers took Perez
                    PEREZ V. CITY OF FRESNO                  7

to the ground to prevent him from running into traffic. While
on the ground, one officer struck Perez’s left side three times
with his knee and then applied a wrist lock. At the same time,
another officer reported that Perez was being combative.
Two additional FCSO deputies responded to the scene and
waited in their patrol vehicle on standby. While the officers
on the ground attempted to restrain Perez, his face repeatedly
hit the ground, causing him to bleed. One officer placed a
towel underneath Perez’s chin and face and lifted Perez’s
head off the ground while holding one end of the towel in
each hand. Another officer asked Perez if he could breathe,
and Perez responded that he could. According to the officers,
at this point, Perez was lying on his stomach, but he
continued to kick his legs. The officers applied a RIPP
restraint to Perez’s ankles and looped it around his handcuffs
to control his leg movement. The officers unlooped the
restraint from Perez’s handcuffs when EMS arrived—
approximately thirty seconds to a minute after they applied
this restraint.
    When EMS arrived, the paramedics retrieved a
backboard. Paramedic Morgan Anderson stated that they
were going to attach Perez to the board while he was prone
so that he could be medically transported. The officers
removed the towel holding Perez’s head and assisted the
paramedics in applying the backboard. As this was
happening, Perez yelled that he could not breathe. Anderson
nevertheless told one of the officers to sit on the backboard.
The officer complied and sat on the board for one minute and
thirteen seconds while other officers applied pressure and
worked with Anderson to secure the backboard. After the
seated officer stood up, the paramedics continued securing
Perez to the backboard for another two minutes before
turning him over. Once Perez was placed on his back, the
8                      PEREZ V. CITY OF FRESNO

paramedics discovered that he did not have a pulse. 1 The
paramedics then transported Perez to the hospital, where he
was pronounced dead. The coroner attributed Perez’s death
to compression asphyxia during restraint with
methamphetamine toxicity as another significant
contributor. 2 The coroner classified Perez’s death as a
homicide.
    Perez’s family members sued the officers and Anderson
under 42 U.S.C. § 1983 for violations of the Fourth and
Fourteenth Amendments and the City and County for
municipal liability under Monell v. Department of Social
Services of the City of New York, 436 U.S. 658, 690 (1978),
based on a failure-to-train theory. Plaintiffs also asserted
various state law claims. Defendants moved for summary
judgment asserting qualified immunity, which the district
court granted. While the district court determined that a
reasonable jury could find that the officers violated the
Fourth and Fourteenth Amendment by applying pressure to

1
  Plaintiffs argue that the paramedics failed to check Perez’s pulse and
perform CPR once they turned him over. They point to the testimony of
two officers who stated that they did not see the paramedics perform
these tasks. Other officers, however, stated the opposite, and the
paramedics testified that they performed lifesaving measures. The
bodycam footage appears to show the paramedics checking Perez’s pulse
on his neck after he was turned over. Regardless of any dispute in the
record regarding the paramedics’ actions after Perez was turned over, it
is immaterial to the claims on appeal that concern the use of force against
Perez before he was turned over. See Anderson v. Liberty Lobby, Inc.,
477 U.S. 242, 248 (1986) (“Only disputes over facts that might affect the
outcome of the suit under the governing law will properly preclude the
entry of summary judgment.”).
2
  According to the coroner, the average lethal dose of methamphetamine
is 200 nanograms per milliliter. Perez had ten times that amount in his
bloodstream.
                       PEREZ V. CITY OF FRESNO                           9

the backboard while Perez was prone, 3 it nonetheless
concluded that the officers were entitled to qualified
immunity because at the time of the incident the law did not
clearly establish, nor was it obvious, that the officers’ actions
were unconstitutional. The district court likewise granted
Anderson qualified immunity because existing law did not
clearly establish, nor was it obvious, that Anderson’s
conduct in providing medical care was unconstitutional.
Finally, the district court determined that Plaintiffs presented
insufficient evidence that either the City or the County were
deliberately indifferent to their duty to train their officers on
restraint asphyxia. Having dismissed all of Plaintiffs’ federal
claims, the district court declined to exercise supplemental
jurisdiction over their remaining state-law claims. Plaintiffs
timely appealed.
                           II. DISCUSSION
    Plaintiffs present three issues on appeal: (1) whether the
law-enforcement officers are entitled to qualified immunity;
(2) whether the paramedic is entitled to qualified immunity;
and (3) whether Plaintiffs presented sufficient evidence to
support their Monell claim against the City and the County
based on a failure-to-train theory. We review a district
court’s grant of summary judgment and decision on qualified
immunity de novo. C.V. v. City of Anaheim, 823 F.3d 1252,

3
  The district court concluded that the officers’ other uses of force,
including taking Perez to the ground, administering knee strikes,
applying a wrist lock, using the towel, and utilizing the RIPP restraint,
were not excessive. Plaintiffs do not challenge the district court’s
findings on appeal. While Plaintiffs’ opening brief mentions the towel
and uses the term “hog-tie,” to refer to the RIPP restraint that was
eventually removed when EMS arrived, Plaintiffs present no meaningful
argument that the district court erred in finding that neither use of force
was independently excessive.
10                  PEREZ V. CITY OF FRESNO

1255 (9th Cir. 2016). “[V]iew[ing] the evidence in the light
most favorable to the nonmoving party,” we must
“determine whether there are any genuine issues of material
fact, and decide whether the district court correctly applied
the relevant substantive law.” Johnson v. Barr, 79 F.4th 996,
1003 (9th Cir. 2023) (quoting Animal Legal Def. Fund v.
U.S. Food & Drug Admin., 836 F.3d 987, 989 (9th Cir.
2016)). We address each issue in turn.
                A. Law-Enforcement Officers
    We begin by considering Plaintiffs’ arguments that the
district court erred in granting the law-enforcement officers
qualified immunity. The doctrine of qualified immunity
shields police officers from § 1983 liability unless (1) the
officers “violated a federal statutory or constitutional right,
and (2) the unlawfulness of their conduct was ‘clearly
established at the time’” of the violation. District of
Columbia v. Wesby, 583 U.S. 48, 62–63 (2018) (quoting
Reichle v. Howards, 566 U.S. 658, 664 (2012)). A right is
clearly established when it is “sufficiently clear that every
reasonable official would have understood that what he is
doing violates that right.” Mullenix v. Luna, 577 U.S. 7, 11
(2015) (per curiam) (quoting Reichle, 566 U.S. at 664).
Although there need not be a case directly on point, “existing
precedent must have placed the statutory or constitutional
question beyond debate.” Id. at 12 (quoting Ashcroft v. al-
Kidd, 563 U.S. 731, 741 (2011)). It is insufficient for a legal
principle to merely be “suggested by then-existing
precedent.” Wesby, 583 U.S. at 63. “The precedent must be
clear enough that every reasonable official would interpret it
to establish the particular rule the plaintiff seeks to apply.”
Id. Courts must be careful not to “define clearly established
law at a high level of generality.” Id. (quoting Plumhoff v.
Rickard, 572 U.S. 765, 779 (2014)). Specificity of the rule is
                       PEREZ V. CITY OF FRESNO                          11

critical, particularly “in the Fourth Amendment context,
where . . . ‘[i]t is sometimes difficult for an officer to
determine how the relevant legal doctrine . . . will apply to
the factual situation the officer confronts.’” Luna, 577 U.S.
at 12 (alteration in original) (quoting Saucier v. Katz, 533
U.S. 194, 205 (2001)). Qualified immunity is a “demanding
standard” because it “protects ‘all but the plainly
incompetent or those who knowingly violate the law.’”
Wesby, 583 U.S. at 63 (quoting Malley v. Briggs, 475 U.S.
335, 341 (1986)).
    The officers do not dispute the district court’s conclusion
that a reasonable jury could find that they violated the Fourth
and Fourteenth Amendments by applying pressure to the
backboard while Perez was in a prone position and thereafter
ignoring his statement that he could not breathe. Therefore,
qualified immunity hinges on whether the unlawfulness of
these actions, taken at the direction of medical personnel,
was clearly established when Perez died. 4

4
  The district court determined that the pressure that the officers applied
before the paramedics arrived was “a low quantum of force” and that
“the tipping point in the encounter [between the officers and Perez]
occurred when the backboard was placed on Perez’s back.” As a result,
the district court “focuse[d] mostly on [the] placement of the backboard”
in its summary judgment order. On appeal, Plaintiffs do not challenge
the district court’s non-lethal force analysis of the actions taken before
the backboard was introduced. Instead, Plaintiffs’ arguments are focused
only on the pressure applied to Perez related to securing the backboard
after the paramedics arrived, which they repeatedly contend caused
Perez’s death. As just one example of many, in their Opening Brief on
appeal they contend: “[I]t is simply obvious that it violates the
Constitution for officers and deputies to compress Perez under a board,
disregard his statement that he could not breathe, and apply downward
pressure to the board until he asphyxiated and died.” As a result, the
12                     PEREZ V. CITY OF FRESNO

    Plaintiffs contend that the officers are not entitled to
qualified immunity for three reasons: (1) the officers’
actions were obviously unconstitutional; (2) our decision in
Drummond ex rel. Drummond v. City of Anaheim, 343 F.3d
1052 (9th Cir. 2003), clearly established that the officers’
actions violated the Constitution; and (3) the officers
departed from their training. We first consider Plaintiffs’
assertion that Drummond clearly established the
unconstitutionality of the officers’ actions before addressing
Plaintiffs’ obviousness and departure-from-training
arguments.
                                   i.
    In Drummond, Drummond’s neighbor called the police
because he was afraid that Drummond, who had a history of
mental illness, was going to injure himself by running
through traffic. Id. at 1054. Three officers responded and
found Drummond in a convenience store parking lot,
unarmed, “hallucinating[,] and in an agitated state.” Id. The
officers called for an ambulance to transport Drummond to
the hospital for an involuntary psychiatric hold. Id. While the
ambulance was in route, the officers took Drummond to the
ground, handcuffed him in a prone position, and despite his
lack of resistance, two officers placed the weight of their
bodies on his back and neck. Id. Drummond “repeatedly told
the officers that he could not breathe,” yet the officers
continued to apply their weight to his back and neck. Id. at
1054–55. Several minutes later, the officers bound

dissent’s contention that we are improperly resolving factual disputes in
favor of the officers or improperly assuming that the paramedic’s
instruction that the officers sit on the backboard was the cause of Perez’s
death is incorrect. We are analyzing Plaintiffs’ case as they presented it.
See Greenlaw v. United States, 554 U.S. 237, 243–44 (2008).
                    PEREZ V. CITY OF FRESNO                   13

Drummond’s ankles, and shortly thereafter, he went limp
and stopped breathing. Id. at 1055. Although Drummond
was eventually revived, he sustained significant brain
damage and fell into a permanent coma. Id. Through his
guardian ad litem, Drummond sued the officers under
§ 1983. Id. The district court granted the officers qualified
immunity. Id. Specifically, the district court concluded that
the officers did not violate the Constitution and even if they
did, there was no clearly established law putting them on
notice that their conduct was unconstitutional. Id.
    We reversed. Id. at 1054. We first determined that the
officers’ use of force was excessive. Id. at 1059–60. Then,
we held that the law, as it existed, clearly established that the
force used by the officers under the circumstances was
unlawful. Id. at 1060. We explained that the officers
asphyxiated Drummond by applying their weight to his back
and neck despite him being restrained, nonresistant, and
repeatedly pleading for air. Id. at 1061. Although there was
no Ninth Circuit precedent involving the same facts, we
determined that “[a]ny reasonable officer should have
known that such conduct constituted . . . excessive force.”
Id. We bolstered our conclusion by pointing to recent local
newspaper stories and federal cases describing the dangers
of compression asphyxia and the officers’ own training
materials. Id. at 1061–62.
    While many of the facts in Drummond are disturbingly
similar to this case, we nonetheless conclude that Drummond
did not clearly establish the unconstitutionality of the
officers’ conduct here because this case presents material
factual differences. Cf. Rivas-Villegas v. Cortesluna, 595
U.S. 1, 5–8 (2021) (per curiam) (reversing our denial of
qualified immunity to an officer because we relied on a
materially distinguishable case despite that case also
14                  PEREZ V. CITY OF FRESNO

involving a nonresistant, prone suspect, who was pinned to
the ground by an officer’s knee). The injurious restraint of
Drummond occurred before paramedics arrived, meaning
the officers were not acting under the direction of medical
personnel. Id. at 1054–55. But here, as just discussed, the
only use of force that Plaintiffs challenge is the restraint that
occurred after the paramedics responded to the scene,
determined that Perez needed to be placed on a backboard to
facilitate his transport to the hospital, and Anderson
instructed the officers to assist in securing Perez to the
backboard by sitting on top of him while he was in a prone
position.
    At first glance, this distinction may seem hollow given
the general principle that subordinate officers cannot simply
defer to unlawful orders by their superiors. See, e.g., Baude
v. Leyshock, 23 F.4th 1065, 1074 (8th Cir. 2022); Kennedy
v. City of Cincinnati, 595 F.3d 327, 337 (6th Cir. 2010). But
that is not what happened. The officers did not follow the
paramedic’s direction because he was their superior. The
officers followed the paramedic’s direction because he was
called to the scene to provide medical care and transport.
Indeed, all the officers involved testified that they defer to
medical personnel that respond to the scene of an emergency
on medically-related matters. Nothing in Drummond clearly
establishes that the officers were required to second guess
the paramedics in their effort to provide medical care.
    Given the specific context of this case, we cannot
conclude that Drummond put the officers on fair notice that
their actions—pressing on a backboard on top of a prone
individual being restrained for medical transport, at the
direction of a paramedic working to provide medical care—
was unlawful. See Luna, 577 U.S. at 12 (clearly-established
prong examines “whether the violative nature of particular
                    PEREZ V. CITY OF FRESNO                  15

conduct is clearly established” (quoting al-Kidd, 563 U.S. at
742)); Sharp v. County of Orange, 871 F.3d 901, 911 (9th
Cir. 2017) (prior cases must “articulate[] a constitutional rule
specific enough to alert these deputies in this case that their
particular conduct was unlawful”).
                             ii.
    Alternatively, Plaintiffs argue that, regardless of whether
a specific constitutional violation was clearly established,
the officers are not entitled to qualified immunity because
their conduct was obviously unconstitutional. They contend
that it was obvious that the officers could not lawfully
“compress Perez under a board, disregard his statement that
he could not breathe, and apply downward pressure to the
board until he asphyxiated and died.”
    In the absence of analogous case law, a plaintiff can
nevertheless     surmount     the    clearly-established-law
requirement by demonstrating instead that the constitutional
violation was obvious. See O’Doan v. Sanford, 991 F.3d
1027, 1044 (9th Cir. 2021). An “obvious case” is one where
the officers’ conduct was clearly unlawful. Wesby, 583 U.S.
at 64. As we have recognized, such cases are extraordinarily
“rare” and “especially problematic in the Fourth-
Amendment context.” O’Doan, 991 F.3d at 1044 (citations
omitted).
    The same facts that distinguish this case from
Drummond also demonstrate that the officers’ conduct was
not obviously unconstitutional. A paramedic concluded that
Perez needed to be restrained so that he could be transported
to a hospital and directed the officers involved to help attach
Perez to a backboard while he was laying prone, including
by sitting on the backboard. Under the circumstances, it was
not obvious that applying the backboard in this manner—as
16                    PEREZ V. CITY OF FRESNO

directed by a medical professional trained to respond in
emergency situations—would violate the Constitution. See
id. Thus, we disagree that the obviousness “exception to the
specific-case requirement” applies here. Sharp, 871 F.3d at
912.
                               iii.
    Finally, Plaintiffs contend that the officers are not
entitled to qualified immunity because they departed from
their training. Plaintiffs rely on the Supreme Court’s recent
decision in Lombardo v. City of St. Louis, 594 U.S. 464
(2021) (per curiam). 5 In Lombardo, police officers arrested
Nicholas Gilbert and put him in a holding cell. Id. at 465. An
officer observed Gilbert attempting to hang himself. Id. In
response, several officers entered the cell, and a struggle
ensued. Id. The officers restrained Gilbert in a prone position
and placed pressure on his limbs, back, and torso. Id. at 465–
66. Gilbert pleaded for the officers to stop. Id. at 466. After
struggling in that position for fifteen minutes, Gilbert
stopped breathing and died. Id.
    Gilbert’s parents sued, and the district court granted
summary judgment to the officers “because they did not
violate a constitutional right that was clearly established at
the time of the incident.” Id. “The Eighth Circuit affirmed on
different grounds, holding that the officers did not apply
unconstitutionally excessive force.” Id. The Supreme Court
concluded that the Eighth Circuit was “unclear [as to]

5
  Plaintiffs also cite Cal. Gov’t Code § 7286.5, which prohibits law-
enforcement agencies from “authoriz[ing] techniques or transport
methods that involve a substantial risk of positional asphyxia.” This
section, however, was not enacted until September 2021—four years
after the events of this lawsuit. See Assemb. B. 490, 2021–2022 Leg.,
Reg. Sess. (Cal. 2021).
                    PEREZ V. CITY OF FRESNO                   17

whether [it] thought the use of a prone restraint . . . is per se
constitutional so long as an individual appears to resist
officers’ efforts to subdue him.” Id. at 467. Because the
Eighth Circuit failed to consider evidence such as officer
training and police guidance regarding prone restraint, and
instead may have applied a per se rule, the Supreme Court
vacated and remanded for further inquiry into the facts and
circumstances of the case. Id. at 467–68.
     Plaintiffs argue that, as in Lombardo, the evidence here
demonstrates that “there is well-known police guidance” that
advises officers to remove individuals from their stomachs
once they are handcuffed and because the officers did not
follow this guidance, qualified immunity was inappropriate.
Contrary to Plaintiffs’ argument, Lombardo does not
establish that any violation of police policy or guidance is,
in and of itself, sufficient to deny qualified immunity.
Indeed, the Lombardo Court “express[ed] no view as to
whether the officers used unconstitutionally excessive force
or, if they did, whether Gilbert’s right to be free of such force
in these circumstances was clearly established at the time.”
Id. at 468. The Court took issue only with the Eighth
Circuit’s failure to consider evidence of police training and
guidance on prone restraint when assessing the
reasonableness of the officers’ actions. Id. at 467–68. As we
have explained, official training and guidance can influence
the qualified-immunity analysis, but they are not
determinative. Vazquez v. County of Kern, 949 F.3d 1153,
1164–65 (9th Cir. 2020). “Even if an officer acts contrary to
[his] training . . . , that does not itself negate qualified
immunity where it would otherwise be warranted.” City &
County of San Francisco v. Sheehan, 575 U.S. 600, 616
(2015).
18                     PEREZ V. CITY OF FRESNO

    While Plaintiffs present evidence that both FPD and
FCSO train their officers not to leave an individual laying on
his stomach once secured, Plaintiffs do not point to any
policy prohibiting such restraint to facilitate medical
treatment. In fact, four of the seven officers involved in the
incident testified that they are trained to defer to paramedics
on issues of treatment and transport when they assist in an
emergency. 6 Thus, Plaintiffs have not presented evidence
that the officers departed from their training under these
specific circumstances. More important, however, for the
reasons previously explained, the officers are entitled to
qualified immunity because the law did not clearly establish,
nor did the context of this case make it obvious, that applying
pressure to the backboard at Anderson’s direction was
unlawful. Even if the officers contravened their training, that
does not defeat qualified immunity in this case. See id.
                          B. The Paramedic
    We next address whether Anderson is entitled to
qualified immunity for his role in Perez’s death. Because we
conclude that the law did not clearly establish at the time of
the events at issue that a paramedic restraining a person in
order to secure the person for medical transport could be held
liable for a constitutional violation under either the Fourth or
Fourteenth Amendment, we conclude that Anderson is
entitled to qualified immunity. See Wesby, 583 U.S. at 63–
64 (clearly established question must be specific to the
context of the case). We do not address the separate question

6
  The other three officers also testified that they defer to paramedics’
judgment but that they do so based on personal experience or because
the situation is medical.
                   PEREZ V. CITY OF FRESNO                 19

of whether Anderson’s actions constituted a constitutional
violation.
    As the district court noted, there are few cases applying
Fourth and Fourteenth Amendment standards to paramedics
responding to medical emergencies. And we have not found,
nor have Plaintiffs cited, any Supreme Court or Ninth Circuit
precedent establishing constitutional liability under similar
circumstances. However, some of our sister circuits have
addressed this context. For example, the Sixth Circuit has
held that whether a paramedic is “entitled to qualified
immunity depends on whether [he] acted in a law-
enforcement capacity or in an emergency-medical-response
capacity when engaging in the [complained-of] conduct.”
McKenna v. Edgell, 617 F.3d 432, 439–40 (6th Cir. 2010);
Peete v. Metro. Gov’t of Nashville & Davidson County, 486
F.3d 217, 221 (6th Cir. 2007). That court reasoned that if the
paramedic was acting in a law-enforcement capacity when
he engaged in the challenged conduct, then the plaintiff’s
claim is properly raised under § 1983, but if the paramedic
was acting in a medical capacity, then the plaintiff’s claim
properly sounds in medical malpractice. See McKenna, 617
F.3d at 440.
    In Peete, the Sixth Circuit reversed the denial of
qualified immunity for paramedics who restrained and
applied pressure to an unconscious patient in a prone
position, thereby causing the patient’s death. 486 F.3d at
220. That court determined that “there is no federal case
authority creating a constitutional liability for the
negligence, deliberate indifference, and incompetence” of
paramedics where their “purpose is to render solicited aid in
an emergency rather than to enforce the law, punish, deter,
or incarcerate.” Id. at 221. The Sixth Circuit likewise
explained in McKenna that if there is any constitutional
20                  PEREZ V. CITY OF FRESNO

“right to be free from . . . unintentional conduct by medical-
emergency responders . . . , it is not clearly established.” 617
F.3d at 440.
    Similarly, the Seventh Circuit granted qualified
immunity to a paramedic who sedated an injured arrestee
before taking the arrestee to the hospital because it was not
clearly established that such conduct violates the Fourth
Amendment. Thompson v. Cope, 900 F.3d 414, 422–24 (7th
Cir. 2018). In Thompson, a paramedic was dispatched to the
scene of an animal bite, but when he arrived, he discovered
that the bite came from a human—Dusty Heishman. Id. at
418. An officer asked the paramedic to examine Heishman
before treating the bite patient. Id. The paramedic suspected
that Heishman was under the influence of drugs and injected
him with a sedative before placing him in an ambulance. Id.
Once in the ambulance, the paramedic determined that
Heishman was not breathing and had no pulse, and despite
the paramedic restoring Heishman’s heartbeat, he died eight
days later. Id. The district court granted the paramedic
qualified immunity against Heishman’s estate’s deliberate-
indifference claim but denied qualified immunity on the
excessive-force claim. Id. at 419. The Seventh Circuit
reversed because the “[c]ase law did not (and does not)
clearly establish that a paramedic can violate a patient-
arrestee’s Fourth Amendment rights by exercising medical
judgment to administer a sedative in a medical emergency.”
Id. at 417. The fact that the paramedic was “confronting a
patient suffering from a life-threatening emergency” took
the “case out of the realm of clearly established Fourth
Amendment law.” Id. at 424. But the court noted that the
question would be more difficult if the paramedic sedated
someone at the direction of law enforcement when there was
no medical purpose for sedation. Id. at 424 n.2.
                   PEREZ V. CITY OF FRESNO                 21

    More recently, the Eighth Circuit confronted similar
claims in Buckley v. Hennepin County, 9 F.4th 757 (8th Cir.
2021). There, paramedics responded to an emergency call
from police concerning a woman who had been drinking and
was threatening self-harm. Id. at 759. The paramedics
determined that the woman needed to be transported to the
hospital, but she refused. Id. Despite her objections, the
officers and paramedics restrained her and carried her to the
ambulance, where the paramedics administered a sedative.
Id. The woman immediately developed respiratory distress
and was intubated. Id. at 759–60. The district court
dismissed the woman’s claims against the paramedics, and
the Eighth Circuit affirmed. Id. at 760, 765. The court
determined that when the paramedics injected the woman,
they were acting in a medical capacity. Id. at 761. The court
then concluded that the paramedics’ actions were not
unreasonable given the woman’s “intoxicated, suicidal,
[and] semi-conscious” state. Id. at 762. Further, the court
explained that the paramedics’ attempt to transport the
woman in need of medical care to a hospital demonstrated
concern, not indifference, for her well-being. Id. at 764. The
fact that the paramedics sedated the woman to protect her, as
well as themselves, from harm did not change the court’s
analysis. Id.
    Here, Plaintiffs agree that “paramedics who act with a
medical purpose backed up by plausible medical judgment”
are entitled to qualified immunity, even if they make a
mistake. But they argue that Anderson “went beyond
providing ‘medical care’” by assisting and directing law
enforcement in restraining Perez. Indeed, Plaintiffs contend
22                     PEREZ V. CITY OF FRESNO

that Anderson’s actions do not constitute medical care at all
because he caused Perez’s death. 7 We disagree.
    Plaintiffs did not present evidence from which a
reasonable jury could find that Anderson was acting in a law-
enforcement capacity during his interaction with Perez. See
McKenna, 617 F.3d at 441–43 (state actor’s role is generally
a question for the jury but courts may answer the question
“as a matter of law when a reasonable jury could come to but
one conclusion”); cf. Johnson, 79 F.4th at 1003 (existence of
probable cause is generally a jury question but courts may
decide the issue “if ‘no reasonable jury could find an absence
of probable cause under the facts’” (quoting Gasho v. United
States, 39 F.3d 1420, 1428 (9th Cir. 1994))). The paramedics
arrived on the scene in response to a medical-emergency call
reporting an individual who was a danger to himself and
others. Their actions throughout the incident were taken for
the purpose of transporting Perez to the hospital for medical
treatment. Anderson determined that before Perez could be
transported in the ambulance, he needed to be secured to a
backboard. And Anderson directed the officers to assist in
restraining Perez while he was lying on the ground so that he

7
  Plaintiffs also argue that because Anderson conceded at summary
judgment that he was acting under color of law, the district court should
have treated him like a law-enforcement officer and denied qualified
immunity. Plaintiffs are mistaken. Whether an individual acts under
color of state law is a different inquiry than whether an individual is
entitled to qualified immunity. The color-of-law question simply asks
whether a defendant “exercised power possessed by virtue of state
law”—a prerequisite “[t]o state a claim under § 1983.” West v. Atkins,
487 U.S. 42, 48–49 (1988) (internal quotation marks omitted) (quoting
United States v. Classic, 313 U.S. 299, 326 (1941)). The qualified-
immunity question, on the other hand, asks whether an individual who
acted under color of state law to deprive another of his federal rights is
nevertheless immune from suit. See O’Doan, 991 F.3d at 1035–36.
                       PEREZ V. CITY OF FRESNO                        23

could be attached to the backboard. In the over 15-minute
video of the incident, there is no indication from Anderson,
or any of the officers, that Perez was ever restrained so that
he could be arrested or punished. Rather, the comments of
all involved during the incident were focused on Perez’s
agitated state and trying calm him down so that he could be
transported for treatment. After the backboard was secured,
Anderson and the other paramedics turned Perez over in
preparation for placing him on the gurney and determined
that he did not have a pulse. While the impact of these
actions is heart-rending, and Anderson’s conduct may have
fallen well short of any reasonable standard of care, the
record establishes that he was trying to render medical aid to
Perez. 8 Cf. Peete, 486 F.3d at 222 (concluding that
paramedics who asphyxiated their unconscious patient
“were attempting to help him, although they badly botched
the job”).
    Because we conclude that Anderson was acting in a
medical capacity during the tragic event at issue in this case,
we also conclude that he is entitled to qualified immunity.
There is no precedent imposing constitutional tort liability
on a paramedic who attempts to render emergency medical
aid to a patient by restraining him in preparation for a
medical transport. The district court therefore did not err in
granting summary judgment in favor of Anderson.

8
  Plaintiffs contend that “Anderson’s initial denial, under oath, that he
gave the instruction” to sit on the backboard undermines any conclusion
that he was attempting to provide medical aid to Perez. We are
unpersuaded by this argument. Our focus in determining Anderson’s role
is on the events that occurred on May 10, 2017. See McKenna, 617 F.3d
at 441. That Anderson initially claimed that he did not recall giving the
instruction and could not recognize his own voice in the video does not
undercut the evidence from the day of the event.
24                  PEREZ V. CITY OF FRESNO

                       C. Monell Claims
    Finally, we consider Plaintiffs’ Monell claims against the
City and the County based on a failure-to-train theory.
Municipalities and local governments can be sued under
§ 1983 for constitutional deprivations caused by
governmental policy or custom. Monell, 436 U.S. at 690.
Respondeat superior liability, however, does not exist under
§ 1983. Id. at 691. “In limited circumstances, a local
government’s decision not to train certain employees about
their legal duty to avoid violating citizens’ rights may rise to
the level of an official government policy for purposes of
§ 1983.” Connick v. Thompson, 563 U.S. 51, 61 (2011).
     To prevail on a failure-to-train theory, a plaintiff must
demonstrate that a municipality’s failure to train “amount[s]
to ‘deliberate indifference to the rights of persons with
whom the [untrained employees] come into contact.’” Id.
(second alteration in original) (quoting City of Canton v.
Harris, 489 U.S. 378, 388 (1989)). Deliberate indifference
is a high legal standard, “requiring proof that a municipal
actor disregarded a known or obvious consequence of his
action.” Id. (quoting Bd. of County Comm’rs of Bryan
County v. Brown, 520 U.S. 397, 410 (1997)). Municipal
liability “is at its most tenuous where a claim turns on a
failure to train.” Id. Ordinarily, “[a] pattern of similar
constitutional violations,” rather than proof of a single
incident, is “necessary to demonstrate deliberate
indifference.” Id. at 62–63 (internal quotation marks
omitted) (quoting Brown, 520 U.S. at 409). Nonetheless,
single-incident liability may exist in the rare case where “the
unconstitutional consequences of failing to train” are
“patently obvious.” Id. at 63–64. Merely negligent training
is insufficient to support a Monell claim. Dougherty v. City
of Covina, 654 F.3d 892, 900 (9th Cir. 2011).
                       PEREZ V. CITY OF FRESNO                         25

     Plaintiffs contend that the following evidence creates a
triable issue on their failure-to-train claim: the facts of the
incident, testimony regarding the officers’ unfamiliarity with
the dangers of restraint asphyxia, and Plaintiffs’ expert
report describing the inadequacies in FPD’s and FCSO’s
training on the risks of prone restraint. But what is missing
is any evidence pointing to a pattern of excessive-force
incidents by untrained officers that resulted in the outcome
here—restraint asphyxia. 9 Accordingly, to establish a
question of fact regarding municipal liability, Plaintiffs
needed to show that the unconstitutional consequences of
failing to train officers on restraint asphyxia were “patently
obvious.” Thompson, 563 U.S. at 64. They did not.
    As an initial matter, Plaintiffs acknowledge that FPD and
FCSO maintain policies to prevent restraint and positional
asphyxia. While two FPD officers testified that they were not
trained on prone-restraint asphyxia, a third FPD officer
testified that he was trained and was taught to monitor a
prone individual’s breathing. Likewise, a FCSO deputy
stated that it is unlikely that an individual would asphyxiate
from downward pressure while in a prone restraint but
nevertheless explained that he was trained to monitor for
signs of restraint asphyxia. The possible inadequate training
of two FPD officers about the risks of restraint asphyxia is
insufficient to support a Monell claim. See Harris, 489 U.S.
at 390–91 (“That a particular officer may be unsatisfactorily
trained will not alone suffice to fasten [municipal]

9
  Because Plaintiffs do not challenge the district court’s finding that no
constitutional violation resulted from the officers’ other uses of force,
see supra note 3, Monell liability cannot flow from those acts. See
Lockett v. County of Los Angeles, 977 F.3d 737, 741 (9th Cir. 2020)
(“Monell claims . . . require a plaintiff to show an underlying
constitutional violation.”).
26                  PEREZ V. CITY OF FRESNO

liability . . . , for the officer’s shortcomings may have
resulted from factors other than a faulty training program. It
may be, for example, that an otherwise sound program has
occasionally been negligently administered.” (citations
omitted)).
    Additionally, to the extent Plaintiffs rely on the officers’
noncompliance with their training, their theory of liability
against the City and the County impermissibly rests on the
mere existence of an employer-employee relationship, rather
than a governmental policy or custom. See Monell, 436 U.S.
at 691–92 (explaining that a municipality is not liable merely
because an employee commits a constitutional violation).
Even “adequately trained officers occasionally make
mistakes; the fact that they do says little about the training
program or the legal basis for holding the city [or county]
liable.” Harris, 489 U.S. at 391. Because Plaintiffs presented
insufficient evidence to establish deliberate indifference, we
affirm the district court’s dismissal of Plaintiffs’ Monell
claims.
                           *****
    Joseph Perez’s death was a tragedy. But that alone does
not dictate the outcome of this case. Because the law-
enforcement officers’ actions that Plaintiffs contend led to
Perez asphyxiating were taken at the direction of a medical
professional who was trying to provide medical care, both
the officers and the paramedic are entitled to qualified
immunity. The district court also properly granted summary
judgment against Plaintiffs’ Monell claims because
Plaintiffs presented insufficient evidence that the City and
the County were deliberately indifferent to their duty to
properly train their law-enforcement officers.
     AFFIRMED.
                    PEREZ V. CITY OF FRESNO                  27

S.R. THOMAS, Circuit Judge, concurring in part and
dissenting in part:
    I concur in the majority’s analysis of the paramedic
liability and failure-to-train claims, and join in affirming the
district court’s grant of summary judgment for Anderson,
AA, FSCO, and FPD. However, I respectfully disagree with
the conclusion that the law governing the conduct of the
individual officer defendants (“Officers”) was not “clearly
established” in 2017.          Extensive federal case law,
departmental guidance, and common sense gave Officers
fair warning that applying continuous force to the back of a
prone person who claims he cannot breathe is
constitutionally excessive. Any argument that Officers’
continued force was nonetheless “reasonable” under the
circumstances turns on disputed issues of material fact—not
confusion about “what the law requires.” Saucier v. Katz,
533 U.S. 194, 205 (2001). Therefore, I respectfully dissent
in part.
                               I
    Fourteen years before Joseph Perez was killed, we held
that police officers violated the clearly established rights of
Brian Drummond when they “crushed [him] against the
ground” while he was laying on his stomach, handcuffed and
awaiting an ambulance. Drummond v. City of Anaheim, 343
F.3d 1052, 1061 (9th Cir. 2003). Like Perez, Drummond
“told the officers he could not breathe,” but they continued
to press on his back anyway. Id. at 1054.
    Applying the factors for excessive force from Graham v.
Connor, 490 U.S. 386, 396 (1989), we concluded that “only
minimal force” was permitted “once Drummond was
handcuffed and lying on the ground.” Drummond, 343 F.3d
at 1058. “Balancing the severe force against the minimal
28                  PEREZ V. CITY OF FRESNO

need,” id., we rejected the officers’ qualified immunity
defense:

       The officers—indeed, any reasonable
       person—should have known that squeezing
       the breath from a compliant, prone, and
       handcuffed individual despite his pleas for air
       involves a degree of force that is greater than
       reasonable.

Id. at 1059. While there was “no federal case directly on
point” at the time, we held that existing decisional law, local
newspaper publicity about compression asphyxia, and
departmental training all contributed to putting the officers
“on notice” that the force they used “amounted to a
constitutional violation.” Id. at 1062; see also Vasquez v.
Cnty. of Kern, 949 F.3d 1153, 1164–65 (9th Cir. 2020)
(analyzing officer training and departmental guidance as
indicia of obviousness).
    Between 2003 and 2017, six of our sister circuits reached
a similar conclusion concerning use of prone compression
on a subject who has been restrained. McCue v. City of
Bangor, Maine, 838 F.3d 55, 64–65 (1st Cir. 2016); Rogoz
v. City of Hartford, 796 F.3d 236, 247–48 (2d Cir. 2015);
Weigel v. Broad, 544 F.3d 1143, 1155 (10th Cir. 2008);
Abdullahi v. City of Madison, 423 F.3d 763, 775 (7th Cir.
2005); Champion v. Outlook Nashville, Inc., 380 F.3d 893,
903 (6th Cir. 2004); Bornstad v. Honey Brook Twp., 211 F.
App’x 118, 124 (3d Cir. 2007) (mem.). During this same
period, we repeatedly held that Drummond supplied clearly
established law for cases involving prone restraint by law
enforcement, notwithstanding slight factual variations, see
Zelaya v. Las Vegas Metro. Police Dep’t, 682 F. App’x 565,
                    PEREZ V. CITY OF FRESNO                 29

567 (9th Cir. 2017) (mem.); Abston v. City of Merced, 506
F. App’x 650, 652 (9th Cir. 2013) (mem.); Tucker v. Las
Vegas Metro. Police Dep't, 470 F. App’x 627, 629 (9th Cir.
2012) (mem.); Arce v. Blackwell, 294 F. App’x 259, 261 (9th
Cir. 2008) (mem.), as did lower courts in the Ninth Circuit.
See, e.g., Garlick v. Cnty. of Kern, 167 F. Supp. 3d 1117,
1155 (E.D. Cal. 2016); Brown v. City & Cnty. of San
Francisco, No. 11-02162, 2014 WL 1364931 at *14 (N.D.
Cal. Apr. 7, 2014); Madrid v. City of Fresno, No. 108 CV
00098, 2011 WL 13243581 at *13 (E.D. Cal. Feb. 23, 2011).
    Drummond and its progeny provide law enforcement
with notice of a common-sense rule: it is unconstitutional to
place prolonged body weight force on the back of prone and
unarmed individual who cannot meaningfully resist. See
Drummond, 343 F.3d at 1059; Abston, 506 Fed. App’x at
653. The law is especially clear where, as here, the prone
individual verbally communicates that he cannot breathe.
Drummond, 343 F.3d at 1061; Arce, 294 F. App’x at 261.
                              II
    The majority acknowledges the “disturbing[]”
similarities between this case and Drummond. In both cases,
the police encounter began on the side of a road after officers
were summoned to care for an individual acting erratically
and in need of psychiatric care. Like Drummond, Perez was
unarmed and initially posed no threat to officer safety, but
was handcuffed for his own protection from nearby traffic.
343 F.3d at 1054. Once handcuffed, both men were
subsequently tackled to the ground and held on their
stomachs before the ambulance arrived. Id. Like the
defendants in Drummond, law enforcement in Fresno
received specific guidance warning of the risks of prone
30                     PEREZ V. CITY OF FRESNO

restraints and positional asphyxia, which Officers seem to
have forgotten or ignored. 343 F.3d at 1059.
    Nevertheless, the majority purports to distinguish this
case based on the arrival of a paramedic on the scene,
approximately ten minutes into the prone restraint. This is a
hollow distinction that turns improperly on unresolved
questions of fact. To hold otherwise disregards “the
Supreme Court’s admonition that ‘officials can still be on
notice that their conduct violates established law even in
novel factual circumstances.’” Torres v. City of Madera,
648 F.3d 1119, 1129 (9th Cir. 2001) (quoting Hope v. Pelzer,
536 U.S. 730, 741 (2002)).
    The majority’s comparison to Drummond reflects
Officers’ version of events, in which the asphyxiation
occurred as a result of reasonable but misguided deference
to the direction of medical personnel. This view
impermissibly resolves several factual questions in favor of
Officers, rather than Perez. Saucier, 553 U.S. at 201. First,
the majority assumes that it was the paramedic’s instruction
that caused Officers to employ unconstitutional force. This
issue is contestable, especially since the instruction occurred
some fifteen minutes after Officers began pressing on
Perez’s back, under conditions nearly identical to those in
Drummond. The degree to which that initial pressure
contributed to Perez’s death is disputed. 1 As is the degree to

1
  While the district court’s analysis focused “mostly” on the quantum of
pressure applied after the placement of the backboard, the court also
recognized that the “struggles and pressure leading up to the placement
of the backboard” may have played a contributing role. In crediting the
coroner’s finding that the cause of death was “compression asphyxia
during restraint,” the court never indicated that only the period after the
                       PEREZ V. CITY OF FRESNO                       31

which the paramedic began directing the scene and Officers
“did defer” after the ambulance arrived.
    Second, the majority accepts that Officers’ decision to
keep pressing was “reasonable” because a paramedic was
present. Whether this decision was indeed reasonable turns
on factual questions, such as Officers’ perception of Perez’s
struggle to breathe and the substance of Officers’ training.
“Because the reasonableness standard ‘nearly always
requires a jury to sift through disputed factual
contentions . . . summary judgment . . . in excessive force
cases should be granted sparingly.’” Torres, 648 F.3d at
1125 (quoting Santos v. Gates, 287 F.3d 846, 853 (9th
Cir.2002)). “This principle applies with particular force
where,” as here, “the only witness other than [the
defendants] was killed during the encounter.” Gonzalez v.
City of Anaheim, 747 F.3d 789 (9th Cir. 2014) (en banc).
    Even if the paramedic did direct the application of lethal
force, police officers are not immunized from obviously
unconstitutional conduct merely because they were
following instructions. See California Att’ys for Crim. Just.
v. Butts, 195 F.3d 1039, 1050 (9th Cir. 1999) (“a reasonable
police officer should have known that this conduct was
improper . . . whether or not the conduct was endorsed by
training materials”); Grossman v. City of Portland, 33 F.3d
1200, 1209 (9th Cir.1994) (“Where a statute authorizes
official conduct which is patently violative of fundamental

placement of the backboard was relevant. To the contrary, the district
court quoted the coroner’s description of a “ten minute restraining
process”—a duration that clearly extends beyond the time the backboard
was in place. The majority’s assertion that “the only use of force that
Plaintiffs challenge is the restraint that occurred after the paramedics
responded” is unfounded.
32                  PEREZ V. CITY OF FRESNO

constitutional principles, an officer who enforces that statute
is not entitled to qualified immunity”); Kennedy v. City Of
Cincinnati, 595 F.3d 327, 337 (6th Cir. 2010) (“[S]ince
World War II, the ‘just following orders’ defense has not
occupied a respected position in our jurisprudence, and
officers in such cases may be held liable under § 1983 if
there is a reason why any of them should question the
validity of that order.”) (quoting O’Rourke v. Hayes, 378
F.3d 1201, 1210 n.5 (11th Cir. 2004)).
    We have never held that compliance with an
unconstitutional order should be treated differently just
because the order comes from someone other than a direct
supervisor. To the contrary, we have held that constitutional
liability extends to all “integral participants” in the
constitutional violation, including those who merely fail to
intercede in unconstitutional conduct before them. See
Green v. City & Cnty of San Francisco, 751 F.3d 1039, 1051
(9th Cir. 2014); Tobias v. Arteaga, 996 F.3d 571, 583–84
(9th Cir. 2021).
                              III
    In sum, Drummond clearly establishes the law in this
case. The Officers’ argument that their conduct was
nonetheless reasonable requires us to decide factual
questions that should be resolved by a jury. As such, I
respectfully dissent from the affirmation of summary
judgment for the individual officer defendants.