Opinion
No. C 01-02345 CRB
January 27, 2004
MEMORANDUM AND ORDER
This civil rights lawsuit arises out of the suicide of Will Henry, a ward of the San Mateo County juvenile court. Now before the Court are defendants' motions for summary judgment. The primary issue is whether defendants were deliberately indifferent to Will's medical needs. After carefully considering the papers filed by the parties, and having had the benefit of oral argument, defendants' motions for summary judgment are GRANTED as to all claims against Luke Moix, M.D., and as to the federal claims against the Daytop Village defendants.
BACKGROUND
Will Henry, age 15, was adjudged a ward of the San Mateo County juvenile court pursuant to California Welfare and Institutions Code Section 602. On April 19, 2000, Will was placed in McAuley Neuro-psychiatric Institute ("St. Mary's"). Approximately five days later, Dr. Moix discharged Will to juvenile hall.
For three weeks Will stayed at Hillcrest, juvenile hall, awaiting admission to Daytop Village. Daytop Village ran a facility which provided substance abuse treatment in a setting which provides no level of security for minors who are wards of the San Mateo County Superior Court. Will was finally admitted to Daytop Village on May 22, 2001. A few weeks later Will walked out of Daytop and killed himself. This lawsuit followed.
PROCEDURAL HISTORY
Plaintiffs, the parents and sole heirs of Will, subsequently filed this lawsuit in federal court against several defendants including St. Mary's Hospital, Dr. Moix, two San Mateo probation officers, Daytop Village, and various Daytop Village employees. They made claims for a violation of section 1983 based on deliberate indifference to a serious medical need, and conspiracy to violate section 1983, as well as state law claims for medical malpractice and negligence. Plaintiffs also alleged that the County of San Mateo and St. Mary's had a policy of deliberate indifference to County patients. Plaintiffs subsequently amended the complaint to add Eli Lilly, the manufacturer of Prozac, as a defendant. Eli Lilly later settled with plaintiffs.
After three rounds of motions to dismiss the following claims remain: (1) Dr. Luke Moix: medical negligence, wrongful death and survivorship, and 42 U.S.C. § 1983; (2) St. Mary's Medical Center: medical negligence, wrongful death and survivorship, and 42 U.S.C. § 1983; (3) Daytop Village defendants: medical negligence, wrongful death and survivorship, and 42 U.S.C. § 1983; and (4) San Mateo County: derivative liability for Daytop Village's negligence.
All remaining defendants now move for summary judgment on all claims, state and federal.
SUMMARY JUDGMENT STANDARD
Summary judgment is proper when "the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue as to any material fact and that the moving party is entitled to a judgment as a matter of law." Fed.R.Civ.P. 56(c). An issue is "genuine" only if there is a sufficient evidentiary basis on which a reasonable fact finder could find for the nonmoving party, and a dispute is "material" only if it could affect the outcome of the suit under governing law. See Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248-49 (1986). A principal purpose of the summary judgment procedure "is to isolate and dispose of factually unsupported claims." Celotex Corp. v. Catrett, 477 U.S. 317, 323-24 (1986). "Where the record taken as a whole could not lead a rational trier of fact to find for the non-moving party, there is no `genuine issue for trial.'" Matsushita Elec. Ind. Co. v. Zenith Radio, 475 U.S. 574, 587 (1986).
"In considering a motion for summary judgment, the court may not weigh the evidence or make credibility determinations, and is required to draw all reasonable inferences in a light most favorable to the non-moving party." Freeman v. Arpaio, 125 F.3d 732, 735 (9th Cir. 1997). However, an inference may be drawn in favor of the non-moving party only if the inference is "rational" or "reasonable" under the governing substantive law. See Matsushita, 477 U.S. at 588. Moreover, in determining whether to grant or deny summary judgment, it is not a court's task "to scour the record in search of a genuine issue of triable fact." Keenan v. Allan, 91 F.3d 1275, 1279 (9th Cir.1996) (internal quotations omitted). Rather, a court is entitled to rely on the nonmoving party to identify with reasonable particularity the evidence that precludes summary judgment. See id.
DISCUSSION
I. DR. LUKE MOIXA. Undisputed Facts
On April 18, 2000, Will's mother, Vicky Henry, called Will's probation officer, Kim Minelli, to have Will taken into custody because she did not want him in her home. That same day the County of San Mateo ("the County") took Will into custody for a probation violation. While Will was being booked into juvenile hall, he informed the booking officer that he was suicidal. The County transferred Will to the San Mateo County Hospital on a California Welfare and Institutions Code section 5150 72-hour detainment. Hospital staff diagnosed Will with adjustment disorder, depression and polysubstance abuse.
The next day Will was transferred to the McAuley Neuropsychiatric Institute at St. Mary's Hospital on a Welfare and Institutions Code section 5150 hold. Dr. Moix first evaluated Will on April 20. He admitted Will on a 5150 hold in order to evaluate him for a major depressive disorder, adjustment disorder with disturbance of mood, and underlying polysubstance abuse. On April 21, Dr. Moix certified Will for further treatment under section 5250 as a danger to himself.
Dr. Moix and McAuley staff saw and assessed Will on a daily basis while he was at McAuley. He was placed on suicide precautions and was checked every 15 minutes during all shifts.
On April 24, Dr. Moix discussed Will returning to juvenile hall. Will expressed anxiety about returning. That same day Dr. Moix started Will on the anti-depressant Prozac at a dose of 10 mg per day.
Dr. Moix again evaluated Will on April 25. Will again reported being anxious about returning to juvenile hall. Dr. Moix increased Will's dosage to 20 mg per day. That same day nursing staff reported that Will was distraught about having to enter drug and alcohol rehabilitation.
Dr. Moix again discussed Will's return to juvenile hall with Will on April 26. Will again expressed anxiety about the discharge and asked not to leave McAuley. Dr. Moix agreed to delay discharge a few days.
On April 27, Will stated that he loved it at McAuley and that he might try to hurt himself if discharged. The nurse who reported the comments interpreted them as a manipulative ploy by Will to stay at McAuley. Will told Dr. Moix that same day that he could not be sure that he would be safe if discharged. Because juvenile hall did not have mental health staff available over the weekend, Dr. Moix delayed Will's discharge until Monday, May 1.
The next day Will repeated that he was anxious about returning to juvenile hall. Dr. Moix documented that juvenile hall was aware of Will's condition and that Will would receive further observation there.
Over the weekend Will was evaluated by the psychiatrist covering for Dr. Moix.
Dr. Moix reassessed Will on May 1 and discharged him to juvenile hall. He discharged Will with a prescription for Prozac 20 mg once daily and a recommendation for structured drug and alcohol treatment, individual therapy and psychiatric follow-up, and monitoring for suicidal ideation. Will committed suicide almost seven weeks later after he walked out of Daytop Village.
B. Analysis
1. Section 1983 claim
Dr. Moix moves for summary judgment on the ground that no reasonable jury could find that the above facts amount to a constitutional deprivation, namely, deliberate indifference to medical needs, and also no reasonable jury could find that Dr. Moix was a state actor and therefore subject to section 1983.
a. State actor
In determining whether a physician providing care to a ward of the state is a state actor, the courts apply a nexus approach. There must be a sufficiently close nexus between the state and the private actor "so that the action of the latter may be fairly treated as that of the state itself." Jensen v. Lane County, 222 F.3d 570, 575 (9th Cir. 2000). The "`State [must be] so far insinuated into a position of interdependence with the [private party] that it was a joint participant in the enterprise."' Id. (quoting Jackson v. Metropolitan Edison Co., 419 U.S. 345, 357-58(1974).
The undisputed evidence establishes as a matter of law that Dr. Moix was not a state actor. "Detailed regulation of and substantial funding for private actors are not sufficient to transform [a] party's conduct into state action." Id. Here, there is not even any evidence of such regulation or funding. McAuley Institute is a private hospital and Will's private insurer-not the County-paid Will's medical bills. In fact, Dr. Moix was not even an employee of McAuley Institute, but rather was an attending physician with admitting privileges at McAuley; he accepted Will as a private patient with private insurance. There is also no evidence that the County played any role in Dr. Moix's treatment decisions, and, in particular, his decision to discharge Will.
The only evidence that supports a finding of Dr. Moix being a state actor is that Will was in state "custody." Plaintiff does not cite any case law, and the Court is aware of none, which supports a finding of a physician as a state actor simply because the physician treated a patient in state custody. As Dr. Moix was not a state actor, summary judgment must be granted on plaintiffs' section 1983 claim.
b. Deliberate indifference
Plaintiffs' section 1983 claim fails for a second reason: no reasonable jury could find that Dr. Moix was deliberately indifferent to Will's medical needs. To prove that Dr. Moix violated Will's constitutional rights (assuming he was a state actor), plaintiffs must show that Dr. Moix knew of a substantial risk of serious harm to Will's health and disregarded the risk by failing to take reasonable measures to abate the risk. See Farmer v. Brennan, 511 U.S. 825, 837 (1994). There must be a purposeful act or failure to act on the part of the defendant and resulting harm. See McGuckin v. Smith, 974 F.2d 1050, 1060 (9th Cir. 1992), overruled on other grounds, WMX Tech. Inc. v. Miller, 104 F.3d 1133 (9th Cir. 1997); Shapley v. Nevada Bd. of State Prison Comm'rs, 766 F.2d 404, 407 (9th Cir. 1985).
Dr. Moix evaluated Will every day. He delayed Will's discharge to juvenile hall to a day when there would be mental health officials available. He started Will on Prozac. He gave instructions to the officials at juvenile hall. In Dr. Moix's medical judgment, Will no longer required hospitalization. Will's parents did not see any problem with Will's discharge, and while Will stated he did not want to be discharged, Dr. Moix reasonably believed that Will simply did not want to go into drug and alcohol rehabilitation. Under these circumstances, no reasonable jury could find that Dr. Moix was deliberately indifferent to Will's medical needs.
Plaintiffs rely exclusively on the declaration of Dr. Edward Hyman, a psychologist, to support their claim against Dr. Moix. Dr. Hyman opines that Dr. Moix's care was "below the standard of care" for several reasons.
First, Dr. Hyman contends that Dr. Moix should have given Will a battery of tests when Will was first admitted to McAuley. "Such a failure to assess the patient properly fell short of the standard of care, and ultimately caused Will Henry's death because it led to his unreasonably early discharge, resulted in early termination medical treatment and led to improper recommendations and placement of Will." Second, he contends that Dr. Moix's prescribing Prozac for Will was below the standard of care. Third, he opines that Dr. Moix should have kept Will at McAuley, or at least ensured that Will would be placed in a secure facility.
Dr. Hyman's declaration does not create a genuine dispute as to whether Dr. Moix was deliberately indifferent. Dr. Hyman does not even claim that Dr. Moix was deliberately indifferent, that is, that Dr. Moix knew of a risk to Will's health and failed to take steps to abate that risk; rather, Dr. Hyman merely opines about a difference in opinion as to how Will should have been treated, that is, a breach of the standard of care. Mere malpractice, or even gross negligence, will not suffice to establish deliberate indifference. See Lopez v. Smith, 203 F.3d 1122, 1131 (9th Cir. 2000): see also Jackson v. Mclntosh, 90 F.3d 330. 332 (9th Cir. 1996) (stating that a difference of opinion regarding proper medical treatment is not deliberate indifference). For this reason, too, Dr. Moix is entitled to summary judgment on plaintiffs' section 1983 claim.
2. State law claims
Will killed himself seven weeks after Dr. Moix discharged Will from McCauley. Dr. Moix argues that no reasonable jury could find for plaintiffs on their state law negligence claims because the evidence is insufficient to show, among other things, that Dr. Moix caused Will's death. Dr. Moix supports his motion with the declaration of Dr. Elliot, an adolescent psychiatrist. Plaintiffs again rely exclusively on the declaration of Dr. Hyman to create a genuine dispute. The declaration falls far short.
Dr. Hyman concludes that Dr. Moix's prescribing Prozac for Will caused Will's "psychological deterioration and ultimate death," but he offers no basis for his conclusion. See Kennedy v. Collagen Corp., 161 F.3d 1226, 1227 (9th Cir. 1998) (stating that a district judge may reject expert testimony where the "analytical gap" between the data and the expert's conclusion is too great). This omission is fatal to plaintiffs' claim, especially given that during the seven week interval between Dr. Moix's discharge of Will and Will's suicide Will was treated by other physicians and mental health professionals. See Farwell v. Un, 902 F.2d 282 (4th Cir. 1990) (defendant physician's negligence did not cause patient's suicide where patient committed suicide ten days after last seeing defendant and after being seen by another physician).
Moreover, the record does not indicate that Dr. Hyman is even qualified to give an opinion on whether prescribing Prozac was a breach of the standard of care and whether Prozac contributed to Will's death. Dr. Hyman is a psychologist, not a medical doctor. He cannot and never has prescribed any medications, including Prozac. He does not work, and apparently has never worked, in an inpatient psychiatric facility. He does not explain how he is qualified to testify that Dr. Moix's prescribing Prozac was a breach of the standard of care for psychiatrists in an in-patient facility.
Under California law, "medical personnel are held in both diagnosis and treatment to the degree of knowledge and skill ordinarily possessed and exercised by members of their profession in similar circumstances."Hutchinson v. United States, 838 F.2d 390, 392 (9th Cir. 1988). "This standard of care, which is the basic issue in malpractice actions, can be proven only by expert testimony." Id. "When a defendant moves for summary judgment and supports his motion with expert declarations that his conduct fell within the community standard of care, he is entitled to summary judgment unless the plaintiff comes forward with conflicting expert testimony." Id. Since Dr. Hyman is not qualified to testify as to the standard of care for psychiatrists, plaintiff has essentially not offered any expert testimony that conflicts with Dr. Moix's expert evidence that Dr. Moix's conduct was in accordance with the standard of care for psychiatrists in the community.
Dr. Hyman also opines that Dr. Moix "endorsed the placement of Will Henry" at Daytop Village and that Dr. Moix should have ensured that Will was placed at a more secure facility or that he should have kept him at McAuley. He concludes that Dr. Moix's failure to keep Will at McAuley or place him in a secure facility caused Will's "psychological deterioration and ultimate death." Dr. Hyman's declaration does not create a genuine dispute as to whether Dr. Moix's negligence caused Will's death. First, there is no evidence that Dr. Moix endorsed Will's placement at Daytop. Second, and more importantly, Dr. Hyman offers no basis for his conclusion that Dr. Moix's discharge of Will caused his suicide seven weeks later. See Kennedy, 161 F.3d at 1227. Third, as with the Prozac prescription, Dr. Hyman does not explain how he is qualified to testify as to the standard of care for psychiatrists in in-patients hospitals.
Finally, Dr. Hyman also concludes that Dr. Moix's failure to run a battery of tests on Will was a breach of the standard of care and caused Will's death. As with his other theories, Dr. Hyman offers no basis for his opinion that Dr. Moix's failure to run certain tests caused Will's suicide seven weeks later.
In sum, no reasonable jury could find Dr. Moix responsible for Will's suicide seven weeks after Dr. Moix last saw him. Accordingly, Dr. Moix is entitled to summary judgment on plaintiffs' state law claims.
II. St. Mary's
Plaintiffs concede that their section 1983 claim against St. Mary's fails because no reasonable jury could find that St. Mary's had a policy of discharging patients prematurely to save the County money.
Plaintiffs' negligence claim against St. Mary's is premised on their negligence claim against Dr. Moix. As no rational jury could find that Dr. Moix negligently caused Will's death, no rational jury could find St. Mary's liable. Summary judgment in favor of St. Mary's on all claims must be granted.
III. Daytop Village defendants
A. Undisputed facts
When Will was returned to juvenile hall upon his discharge from McAuley, Will's probation officer requested permission from the court to admit Will to Daytop Village, a residential drug and alcohol treatment program. After approximately three weeks Will was admitted to Daytop. Will was assigned to intern Carmen Goodin under supervision of Dr. Jaimez and Rose Dito. Goodin and Dito were aware of Will's history of depression and substance abuse. Goodin assessed Will for risk of suicide three times between his admission to Daytop and when he escaped on June 18.
On or about June 1, Dr. Mordecai evaluated Will. Will reported some improvement with Prozac. Dr. Mordecai concluded that Will was suffering from major depression and substance abuse and increased Will's Prozac doseage. He also concluded that Will was a good candidate for Daytop's drug treatment program. Dr. Mordecai's report of his evaluation of Will recommended follow-up in two weeks on Will's response to the increased Prozac prescription. On June 13, Will was tested by Dr. Jaimez, a licensed psychologist. Dr. Jaimez was concerned about Will's elevated scores for depression, and accordingly, she met with him personally on June 16 to assess Will for suicide risk. Will denied any intent to commit suicide and agreed not to harm himself.
Two nights after Dr. Jaimez met with Will, Will sneaked out of Daytop's facility. He returned to Pacifica and stayed the night with a friend. The next morning the friend's mother dropped Will off at the home of another friend. Some four hours later Will was discovered, a suicide by hanging.
B. Analysis
1. Section 1983 claim
The Daytop defendants do not dispute that they can be considered state actors; instead, they argue the evidence is insufficient for a reasonable jury to find that any of them was deliberately indifferent to Will's medical needs. Again, the outcome of this motion turns on the declaration of Dr. Hyman, plaintiffs' expert psychologist.
Dr. Hyman opines that given Will's history he should have been given a battery of psychological tests upon Will's admission to Daytop; instead, he received only some those tests three weeks after his admission (but several days before he escaped). Dr. Hyman also opines that Daytop officials misinterpreted the results of those tests and should have ordered Will hospitalized immediately. Finally, Dr. Hyman again opines that Will's Prozac prescription should not have been increased.
Even if everything Dr. Hyman says is true, plaintiffs have not demonstrated deliberate indifference. There is no evidence that defendants believed that what they were doing (or not doing) was not in Will's best interest. There is no evidence, for example, that any of the defendants thought Will posed an actual suicide threat but did nothing about it. Instead, the undisputed evidence establishes that defendants believed that Will was being adequately supervised and was not an actual suicide risk.
Vicky Henry claims that after Will died, Goodin told her that several days before Will killed himself Will told Goodin that he had a plan to steal money from his mom's purse and kill himself. Goodin denies the story. Even if true, however, Will was examined for suicide risk by both Goodin and Dr. Jaimez after he allegedly made that statement. Both concluded that Will was not an active suicide risk. Their conclusions may have been erroneous, but plaintiffs have not pointed to any facts that would support a finding of deliberate indifference, that is, evidence that defendants ignored an obvious risk. See Lopez v. Smith. 203 F.3d 1122, 1131 (9th Cir. 2000). Accordingly, summary judgment in favor of the Daytop defendants must be granted on plaintiffs' section 1983 claim.
2. State law claims
At defendants' request, the Court declines to exercise supplemental jurisdiction of plaintiffs' state law claims against the Daytop defendants. See Acri v. Varian Associates, Inc., 114 F.3d 999, 1001 (9th Cir. 1997) (en banc). Accordingly, plaintiffs' state law claims against the Daytop defendants will be dismissed without prejudice.
CONCLUSION
For the foregoing reasons, Dr. Moix's motion for summary judgment is GRANTED in its entirety, St. Mary's motion for summary judgment is GRANTED in its entirety, and the Daytop defendants' motion for summary judgment on the section 1983 claim is GRANTED. The state law claims against the Daytop defendants are dismissed without prejudice.
IT IS SO ORDERED.