Opinion
3:17-cv-586 (JAM)
08-19-2024
LISHAN WANG, Plaintiff, v. MIRIAM DELPHIN-RITTMON et al., Defendants.
ORDERORDER GRANTING DEFENDANTS' MOTION FOR SUMMARY JUDGMENT
JEFFREY ALKER MEYER UNITED STATES DISTRICT JUDGE
Plaintiff Lishan Wang has filed this lawsuit against several medical staff members of a state-run psychiatric facility. He claims that they violated his constitutional rights while executing a state court order that allowed them to forcibly medicate him with antipsychotic medications in order to render him competent for trial.
I have previously denied the defendants' motion to dismiss Wang's claims on the pleadings. See Wang v. Delphin-Rittmon, 664 F.Supp.3d 205 (D. Conn. 2023). Now the parties have conducted discovery, and the defendants have moved for summary judgment. For the reasons set forth below, I conclude that the defendants are entitled to qualified immunity from Wang's claims. Accordingly, I will grant the defendants' motion for summary judgment.
Background
Wang's troubles began in 2010 when he was charged in Connecticut state court with murder and related crimes. Wang himself was a doctor, and he was principally charged with murdering another doctor and also attempting to murder the victim doctor's wife. See State v. Wang, 323 Conn. 115, 119-20 (2016).
The facts set forth below are based primarily on the parties' respective statements of material fact that have been filed in accordance with Rule 56 of the District of Connecticut's Local Rules of Civil Procedure. This Court's local rules prescribe the manner in which the factual record must be presented for purposes of a motion for summary judgment. In essence, the party who moves for summary judgment must submit a factual statement in the form prescribed under Local Rule 56(a)(1), and the non-moving party must then file an opposing statement in the form prescribed under Local Rule 56(a)(2). See D. Conn. L. Civ. R. 56(a)(1)-(2). Each asserted fact in a moving party's statement must be “supported by the evidence” and, if supported by evidence, “will be deemed admitted ... unless such fact is controverted by” the opposing party's statement. See D. Conn. L. Civ. R. 56(a)(1); see also Fed.R.Civ.P. 56(c) (detailing manner in which a party must lodge an objection to dispute a fact asserted by the moving party). The Court's local rules ensure that a pro se party is thoroughly advised of the procedural requirements for opposing a summary judgment motion, see D. Conn. L. Civ. R. 56(b), and the defendants have complied with the rule's requirement to serve on Wang a notice detailing the rules that govern a motion for summary judgment. Doc. #257. The record citations in footnotes below are primarily to the defendants' Local Rule 56(a)(1) statement, see Doc. #256-2, as well as to Wang's opposing Local Rule 56(a)(2) statement, see Doc. #298. For facts that Wang does not state a proper objection, I cite and rely on the defendants' Local Rule 56(a)(1) statement. On the other hand, for facts to which Wang states a proper objection, I cite Wang's Local Rule 56(a)(2) statement and resolve whether there are adequate grounds for Wang's objection such that there remains a disputed issue of fact.
The prosecution of Wang was delayed by disputes about Wang's mental competency. See id. at 120-121. In April 2015, a state court ordered Wang's commitment for a mental evaluation to the Whiting Forensic Hospital, a secure psychiatric facility run by the State of Connecticut.
Doc. #256-2 at 4 (¶ 16).
Wang was admitted to Whiting with a diagnosis of schizophrenia. The state court appointed a healthcare guardian for Wang, and the guardian in turn recommended that Wang be treated with Olanzapine and Ziprasidone to restore him to competency. These two drugs are used to treat psychotic disorders such as schizophrenia. They are designed to alter the chemical balance in a patient's brain, thereby reducing hallucinations, delusions, and disorganized thought processes.
Ibid. (¶ 17); see also Doc. #259 at 2 (Whiting hospital discharge summary describing Wang's “extremely rigid thinking,” and that he was “paranoid that staff was trying to trick him at times, [and] grandiose in his dismissal of others” and that “[o]verall, his paranoia encompassed guardedness, suspiciousness, and susceptibility to persecutory ideas”). Although Wang disputes that he had schizophrenia, he does not point to facts that are sufficient to genuinely controvert this diagnosis. Moreover, for purposes of this federal court proceeding, Wang expressly disclaims any challenge to the validity of the state court order, see Doc. #298 at 7 (¶ 17 response) (“this civil case is NOT to relitigate the criminal case”), and res judicata otherwise bars Wang from disputing the state court's conclusion that he suffered from a serious mental illness of schizophrenia that justified the involuntary administration of antipsychotic medications. See Wang, 323 Conn. at 121 (discussing expert testimony credited by the state court that Wang “had been diagnosed with ‘unspecified schizophrenia spectrum and other psychotic disorder'”). Moreover, the state court's order of involuntary medication necessarily rested on a conclusion that Wang suffered from a mental illness that rendered him incompetent to stand trial. See Sell v. United States, 539 U.S. 166, 179 (2003) (allowing involuntary medication of a “mentally ill defendant” for purposes of restoring defendant to competency “only if the treatment is medically appropriate,” less intrusive means are ineffective, and the medication is “unlikely to have side effects that may undermine the fairness of the trial).
Doc. #256-2 at 4-5 (¶¶ 18, 20).
Id. at 5 (¶ 21).
Ibid.
The state trial court later granted the prosecution's motion for an order of involuntary medication. It concluded in part that Wang “suffers from a psychotic disorder” and that the forcible medication of Wang with Olanzapine and Ziprasidonewas medically appropriate and necessary to restore him to competency.
Doc. #168-3 at 6-7 (state trial court order).
On appeal, the Connecticut Supreme Court affirmed the state trial court, and then the United States Supreme Court denied certiorari on February 21, 2017. See State v. Wang, 323 Conn. 115 (2016), cert. denied sub nom. Wang v. Connecticut, 580 U.S. 1121 (2017). The very next day-February 22, 2017-Wang was brought from Whiting to state court, and the state court authorized Whiting to execute the order of involuntary medication.
Doc. #256-2 at 5 (¶ 24).
Around 2:30pm that day, Dr. Diana Kurlyandchik ordered 5 milligrams of Olanzapine to be administered to Wang twice daily-orally if Wang cooperated, but intramuscularly if he refused to take the medication orally. Wang refused to take the medication orally, and he also refused to walk to the treatment room, telling staff that “You need to carry me there.” Wang admits stating: “I will protect myself.”
Id. at 6 (¶ 25).
Id. at 6 (¶ 27); Doc. #298 at 17 (¶ 27 response). Specifically, Wang admits in his Rule 56(a)(2) statement that he “refused to take Zyprexa [Olanzapine] by mouth orally,” that he “refused to walk to the treatment room” and that he “told staff (NOT Dr. Kurlyandchik) ‘You need to carry me there.'” Doc. #298 at 17 (¶ 27 response).
Specifically, in response to the defendants' claim that Wang stated “I will protect myself how I have to,” Doc. #256-2 at 6 (¶ 27), Wang admits that he stated “‘I will protect myself' or something to that effect[].” Doc. #298 at 17 (¶ 27 response).
The parties otherwise disagree about whether Wang made verbal threats or engaged in physically aggressive conduct. According to the defendants, Wang yelled “I will not submit to your artillery” and that “you're going to be killed,” and that, when Whiting employees tried to escort Wang to the treatment room, Wang became “physically aggressive, dropping his weight and swinging at them.” But Wang specifically denies these facts. In light of this factual dispute and my obligation to view the summary judgment record in the light most favorable to Wang as the non-moving party, I decline to credit for purposes of this ruling the defendants' claim that Wang made threatening statements or became physically aggressive at any time on February 22, 2017.
Doc. #256-2 at 6 (¶¶ 27, 28).
Doc. #298 at 17 (¶¶ 27-28 responses).
At oral argument the defendants argued that I could disregard Wang's account because it was “self-serving.” But this argument reflects a surprising misunderstanding of basic summary judgment law, which does not allow courts to discount otherwise admissible factual statements of parties merely because they can be characterized as “selfserving” in nature. See Ortega v. Moran, 2022 WL 17092584, at *3 (D. Conn. 2022). Here, Wang is fully competent to offer firsthand evidence concerning what he recalls he said and did at the time. The defendants also argued that I could disregard Wang's account because it was not corroborated by other evidence. Wrong again. It is a very basic principle of summary judgment law that a plaintiff who attests to first-hand knowledge of facts does not have to adduce additional corroborating evidence in order to survive a motion for summary judgment. See id. at *4. As the Second Circuit has made clear, a court at summary judgment may not engage in “judicial evidence weighing” at the expense of its duty to credit the non-moving party's otherwise admissible version of the facts. See Ketcham v. City of Mount Vernon, 992 F.3d 144, 149 (2d Cir. 2021).
At around 2:45pm, Dr. Kurlyandchik ordered Wang's physical restraint with four-point restraints in a restraint room. This was based on her conclusion that Wang posed a serious risk of imminent physical assault, and Wang was then involuntarily injected with five milligrams of court-ordered Olanzapine. While in restraints, pursuant to Whiting policy, Wang was evaluated every fifteen minutes by Whiting nursing staff and every two hours by a Whiting psychiatrist.
Doc. #256-2 at 6-7 (¶¶ 29-31). Although Wang disputes that he posed a risk of serious physical assault, see Doc. #298 at 17 (¶ 29 response), he does not dispute that Dr. Kurlyandchik reached this conclusion as a basis for the order imposing restraints.
Doc. #256-2 at 7 (¶ 32). According to the defendants, nursing staff notes documented Wang's continuing “aggressive behaviors and statements, including, threatening to physically assault or harm staff if restraints were removed, angry affect, agitated behavior, refusal to engage with staff and discuss release from restraints, clenched fists, yelling, and pulling at restraints, continued throughout the two-hour period.” Id. at 7-8 (¶ 35). But for the same reasons as discussed above, I decline for purposes of this ruling to credit the defendants' claim in this respect because, although Wang does not dispute that he remained under constant observation and monitoring, he specifically disputes the truthfulness of these staff notes and insists that he “NEVER threatened physical harms to others.” Doc. #298 at 20 (¶ 35 response).
Around 4:30pm, Dr. Victoria Dreisbach evaluated Wang and also reviewed the staff notes, which showed that, when approached by Dr. Kurlyandchik, Wang had yelled that he did not want to talk. Wang himself admits that he said: “I'm not crazy. You're crazy. I don't need med; you need med. I've Chinese Government behind me. I'll sue you.” Wang also admits that he refused Dr. Kurlyandchik's request that he assure her that he would not assault someone if he were released from the restraints. At about 4:45pm, Dr. Dreisbach concluded that Wang continued to pose an imminent risk of serious physical assault if not restrained, and she reauthorized the continuing use of four-point restraints.
Doc. #256-2 at 8 (¶ 38). Wang does not dispute the defendants' claim that he yelled that he did not want to talk with Dr. Kurlyandchik. Doc. #298 at 23 (¶ 38 response). The defendants, however, further claim that Wang stated "'[n]ow, that you forced medicating I am going to be violent,"' Doc. # 256-2 at 8 (¶ 38). But because Wang insists in response that he “NEVER threatened to physically assault anyone,” Doc. #298 at 23 (¶ 38 response), I decline to credit for purposes of this summary judgment ruling that Wang made the threat of violence that the defendants claim he did.
Doc. #298 at 23 (¶ 38 response).
Doc. #298 at 23 (¶ 38 response) (stating that Dr. Kurlyandchik “wanted Wang to say ‘I'll not assault anyone if released' as a condition to end the restraint,” but “Wang did not make the statement Dr. Kurlyandchik wanted”). Elsewhere in Wang's Rule 56(a)(2) statement he acknowledges “[a]ll day long [he] had been refusing to engage staff and to make any compromised [sic] statement as Dr. Kurlyandchik had demanded it.” Id. at 31 (¶ 54 response). Wang's briefing and affidavit also states that he would not answer Dr. Kurlyandchik when she offered to remove the restraints if he would agree not to physically assault others. Doc. #288 at 49; Doc. #289 at 10 (¶ 20).
Doc. #256-2 at 8-9 (¶ 39). Although Wang disputes that he was violent or threatening, see Doc. #298 at 23 (¶ 39 response), he does not dispute that Dr. Dreisbach re-authorized the restraints on the basis of her conclusion that he posed an imminent risk of harm.
Dr. Dreisbach evaluated Wang again around 6:45pm. Wang yelled that “there is nothing wrong with me.” Wang refused to discuss the behaviors he needed to exhibit to permit his level of restraint and observation to be decreased. Although Wang disputes the defendants' claim that he threatened staff, he does not dispute the defendants' claim that he was angry and agitated. He admits that he “threatened to sue staff” and that he “refused to engage staff, consistent with [his] statement that he kept his mouth shut.”
Doc. #256-2 at 9 (¶ 42).
Doc. #256-2 at 9 (¶ 43). Wang does not deny yelling this statement; he claims that he “repeatedly said ‘This is nothing wrong with me.'” Doc. #298 at 25 (¶ 43 response).
Doc. #256-2 at 9 (¶ 43). Wang does not deny that he refused to discuss his behavior. He claims instead that the defendants had not notified him of the criteria for discontinuation of the restraints. Doc. #298 at 25 (¶ 43 response). Because Wang otherwise disputes the defendants' claim that he used a curse word in the course of refusing to discuss his behavior, see ibid, I decline to credit the defendants' claim that his refusal was accompanied by the use of a curse word.
Compare Doc. #256-2 at 9-10 (¶¶ 41, 44) with Doc. #298 at 25 (¶¶ 41, 44 responses).
Doc. #298 at 25 (¶ 44 response).
Dr. Dreisbach concluded that Wang remained at risk of impulsive physical assault, and so she re-authorized his restraints and also prescribed 50 milligrams of Benadryl to be administered to him with his second dose of Olanzapine at 7:00pm. Benadryl is a short-acting, over-the-counter antihistamine used to treat insomnia, allergy problems, motion sickness, and the common cold in adults and children. It is also used by psychiatrists to prevent or control the side effects of antipsychotic drugs and as a sedative. Olanzapine has been associated with such side effects as agitation, restlessness, and dystonia (continuous spasms and muscle contractions). Benadryl has been shown to decrease these symptoms, and the use of Olanzapine and Benadryl together when starting a course of antipsychotic medication is a common practice.
Doc. #256-2 at 10 (¶ 45). Wang disputes that he was a risk of assault but does not dispute that Dr. Dreisbach reached this conclusion as a basis for continuing the restraints and ordering the administration of Benadryl along with his second dose of Olanzapine. Doc. #298 at 25 (¶ 45 response).
Doc. #256-2 at 10 (¶ 47).
Ibid. (¶ 48).
Id. at 12 (¶¶ 58-59).
Ibid. (¶¶ 60-61).
The defendants claim that the use of an antipsychotic medication such as Olanzapine, together with Benadryl to reduce agitation, is a reasonable and common practice. Wang does not dispute this claim. Instead, he disputes the defendants' right to administer Benadryl without his consent and without Benadryl having been specifically authorized by the state court's medication order.
Ibid. (¶ 62).
Doc. #298 at 33 (¶¶ 58-62 responses) (stating that “the science and clinical use of Benadryl [is] left to Defendants to prove for themselves” but that “Wang had [a] right to refuse it on 02/22/17 because Defendants did not have a court order to inject it into Wang's body against [his] will”).
The defendants also claim that the involuntary administration of Benadryl was consistent with Whiting's operational procedure manual. This manual provides in part for the involuntary administration of short-acting medications like Benadryl if a physician determines based on personal observation that there exists an emergency involving an immediate risk to the patients' wellbeing or to others' physical safety that cannot be addressed through less intrusive means such as with the patient's consent or through seeking and obtaining a court order.
Doc. #256-2 at 13 (¶¶ 64-65).
Dr. Dreisbach conducted another assessment of Wang at approximately 8:45pm. She found him to be uncooperative, refusing to open his eyes or to discuss his need for restraints, and she also found that he remained angry, irritable, and without insight during the preceding two hours. So once again, Dr. Dreisbach re-authorized the continuing use of restraints.
Doc. #256-2 at 10 (¶ 49).
Ibid. In response, Wang insists that he had “NEVER been violent on 02/22/17 and had NEVER posed any risk of physical harm to others,” Doc. #298 at 28 (¶ 49 response), but he does not contest the defendants' claims that he was uncooperative and angry. To the extent that Wang claims that he did not pose a risk of harm to others, this is not a statement of fact but a predictive and conclusory statement that turns on an interpretation and inference to be drawn from the underlying facts about what Wang was saying and how he was acting. A court is not required at summary judgment to credit a non-moving party's conclusory statements. See Woods v. Newburgh Enlarged City Sch. Dist., 288 Fed.Appx. 757, 759 (2d Cir. 2008); Scotto v. Almenas, 143 F.3d 105, 114 (2d Cir. 1998).
Doc. #256-2 at 10 (¶ 49).
Dr. Dreisbach conducted another assessment of Wang at approximately 10:45pm.
Ibid. (¶ 50).
Wang remained agitated. Dr. Dreisbach again re-authorized the continuing use of restraints, and she ordered a second dose of 50 milligrams of Benadryl to be administered along with 10 milligrams of Olanzapine at 11:30pm.
Ibid. The defendants further claim that Wang “continued to threaten to harm hospital staff,” ibid., but I decline to credit this claim for purposes of this summary judgment ruling because Wang insists he made no such threats. Doc. #298 at 28 (¶ 50 response).
Doc. #256-2 at 11 (¶¶ 51-52).
The defendants claim that Dr. Dreisbach prescribed the second dose of Benadryl as a prophylaxis for the adverse effects of the antipsychotic drug, Olanzapine, and as a sedative to enable the Plaintiff to regain control of his behavior sufficiently to be released from restraints without posing a danger to himself or others at Whiting. Although Wang disputes that he was a danger to anyone or that he was experiencing side effects, he does not dispute Benadryl's use as a sedative and as a control for potential side effects of Olanzapine.
Ibid. (¶ 53).
Doc. #298 at 31 (¶ 53 response). Wang disputes that he had any documented side effects from the Olanzapine, id. at 28 (¶ 46 response), but he does not dispute the generally appropriate use of Benadryl as a prophylaxis for potential side effects.
Wang was released from the four-point restraints at 12:45am on the morning of February 23, 2017. He was released because he calmed down and because he assured one of the nurses that he could follow instructions and was neither homicidal nor suicidal.
Doc. #256-2 at 11 (¶ 54).
Ibid. I credit the defendants' claim in light of Wang's admission that he was “drowsy” and does not have a “clear memory” of what he said at the time. Doc. #298 at 31 (¶ 54 response).
At approximately 2:30am Wang fell while using the bathroom, sustaining an injury to the bridge of his nose that prompted him to be taken to a local hospital for treatment. Wang claims-but the defendants dispute-that the cause of his fall was the continuing sedation effects of the Benadryl.
Doc. #256-2 at 13-15 (¶¶ 67-76).
Compare Doc. #298 at 38 (¶ 77 response), with Doc. #256-2 at 15 (¶ 77).
Wang claims that his constitutional rights were violated in two ways. First, he claims that Dr. Kurlyandchik and Dr. Dreisbach, as well as three of the defendant nurses (Clara Mejias, Misty Delciampo, and Heather Madison), violated his right to be free from the use of excessive force when they subjected him to four-point restraints for approximately ten hours from 2:45pm to 12:45am. Second, he claims that Dr. Dreisbach, as well as two of the nurses (Clara Mejias and Judy Hall), violated his right to bodily integrity when they administered Benadryl by force and without his consent.
Doc. #139 at 2 (¶ 1); Doc. #140 at 26.
Id. at 1 (¶ 1); Doc. #140 at 26. The revised amended complaint also named several supervisory defendants, but the Court has previously dismissed Wang's claims against these defendants for lack of allegations that they were personally involved in any deprivation of Wang's constitutional rights. Doc. #140 at 15-18. The Court has also previously dismissed Wang's state law claims. Id. at 19-25.
The defendants have moved for summary judgment on the grounds that they did not use excessive force by means of keeping him in restraints or violate Wang's right to bodily integrity by administering Benadryl without his consent. Alternatively, they move for summary judgment on the ground of quasi-judicial immunity and qualified immunity.
Doc. #256 at 1.
Discussion
The principles governing review of a motion for summary judgment are well established. Summary judgment may be granted only if “the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law.” Fed.R.Civ.P. 56(a). A “judge's function at summary judgment is not to weigh the evidence and determine the truth of the matter but to determine whether there is a genuine issue for trial.” Tolan v. Cotton, 572 U.S. 650, 656 (2014) (per curiam). In assessing whether there is a genuine issue of material fact for trial, a court must view the evidence in the light most favorable to the opposing party and draw all reasonable evidentiary inferences in that party's favor. Id. at 657; Commerzbank AG v. U.S. Bank, N.A., 100 F.4th 362, 374 (2d Cir. 2024).
Unless otherwise noted and for ease of reading, this ruling omits all internal quotations, brackets, and derivative citations for all quotations from cases.
In addition, “it is well established that a court is ordinarily obligated to afford special solicitude to pro se litigants ... particularly where motions for summary judgment are concerned.” Harris v. Miller, 818 F.3d 49, 57 (2d Cir. 2016). But this rule of solicitude “does not relieve [a] pro se plaintiff of his duty to meet the requirements necessary to defeat a motion for summary judgment.” Jorgensen v. Epic/Sony Recs., 351 F.3d 46, 50 (2d Cir. 2003).
Use of four-point restraints
Wang claims that the defendants used excessive force by subjecting him to four-point restraints for approximately ten hours while implementing the state court's antipsychotic medication order. The Due Process Clause of the Fourteenth Amendment protects a pre-trial detainee from the use of excessive force that amounts to punishment, and from actions that are not rationally related to a legitimate, nonpunitive government purpose or actions that are excessive in relation to that purpose. See Kingsley v. Hendrickson, 576 U.S. 389, 397-400 (2015); Frost v. New York City Police Dept., 980 F.3d 231, 251-52 (2d Cir. 2020).
When deciding whether a defendant has engaged in excessive force in violation of the due process rights of a pre-trial detainee, a court must apply an objective reasonableness standard and apply that standard from the perspective of and in light of the facts known to the defendant at the relevant time. See Frost, 980 F.3d at 252 (citing Kingsley, 576 U.S. at 399). A court should take into account multiple factors such as “‘the relationship between the need for the use of force and the amount of force used; the extent of the plaintiff's injury; any effort made by the officer to temper or to limit the amount of force; the severity of the security problem at issue; the threat reasonably perceived by the officer; and whether the plaintiff was actively resisting.'” Ibid. (quoting Kingsley, 576 U.S. at 397). And where-as here-the alleged use of excessive force arises in an institutional context such as a prison or secure mental health facility, a court must also “‘take account of the legitimate interests in managing [the institution], acknowledging as part of the objective reasonableness analysis that deference to policies and practices needed to maintain order and institutional security is appropriate.'” Ibid. (quoting Kingsley, 576 U.S. at 399-400).
Courts give great deference to the judgment of mental health professionals about what degree of force or restraint is necessary for reasons of safety in the context of treating a mental health patient. That is the long-established rule of Youngberg v. Romeo, 457 U.S. 307 (1982), a case involving in part a constitutional challenge to the use of physical restraints against intellectually disabled residents of a state-run facility. The Supreme Court ruled that the State had an “unquestioned duty to provide reasonable safety for all residents and personnel within the institution,” and that “it may not restrain residents except when and to the extent professional judgment deems this necessary to assure such safety or to provide needed training.” Id. at 324. It emphasized that “mental health professionals' treatment decisions are ‘presumptively valid,' and this presumption is overcome ‘only when the decision by the professional is ... a substantial departure from accepted professional judgment, practice, or standards.'” Monaco v. Sullivan, 737 Fed.Appx. 6, 11 (2d Cir. 2018) (quoting Youngberg, 457 U.S. at 323).
The Supreme Court in Youngberg went on to hold that “liability may be imposed only when the decision by the professional 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.” 457 U.S. at 323. In other words, “decisions made by the appropriate professional are entitled to a presumption of correctness,” id. at 324, and mental health professionals “should not be required to make each decision in the shadow of an action for damages.” Id. at 325; see also Lurch v. Chaput, 2023 WL 2469943, at *2-3 (2d Cir. 2023) (quoting Kulak v. City of New York, 88 F.3d 63, 75 (2d Cir. 1996) (affirming grant of summary judgment for doctor and nurse against claim that they improperly used restraints and involuntary medication and noting that “[w]ith physical restraint and forcible administration, a medical professional is not liable unless the decision is a ‘substantial departure from accepted judgment, practice, or standards'”)).
In addition, the defendants here have asserted a defense of qualified immunity. The doctrine of qualified immunity protects government employees-such as the medical staff of Whiting Forensic Hospital-from liability for money damages stemming from a violation of the Constitution if the employee engaged in conduct that an objectively reasonable person would not necessarily have known at the time amounted to a violation of the plaintiff's constitutional rights. See Horn v. Stephenson, 11 F.4th 163, 168-69 (2d Cir. 2021). Thus, the doctrine of qualified immunity functions as a rule of deference to government officials or employees when they act in the face of uncertainty about whether their conduct violates constitutional rights. It protects “‘all but the plainly incompetent or those who knowingly violate the law.'” Wiggins v. Griffin, 86 F.4th 987, 994 (2d Cir. 2023) (quoting Malley v. Briggs, 475 U.S. 335, 341 (1986)).
A defendant bears the burden to prove they are entitled to qualified immunity. See Murphy v. Hughson, 82 F.4th 177, 184 (2d Cir. 2023). Thus, a defendant must show that they did not violate a statutory or constitutional right of the plaintiff that was clearly established law at the time of the conduct in question. See Horn, 11 F.4th at 168-69. A clearly established right is one that is “‘sufficiently clear that every reasonable official would have understood that what he is doing violates that right.'” Radwan v. Manuel, 55 F.4th 101, 114 (2d Cir. 2022) (quoting Reichle v. Howards, 566 U.S. 658, 664 (2012) (emphasis added)). Put differently, “[i]f reasonable officers could disagree on the legality of the action at issue in its particular factual context, the officer is entitled to qualified immunity.” Soukaneh v. Andrzejewski, -- F. 4th --, 2024 WL 3747703, at *4 (2d Cir. 2024) (quoting Guan v. City of New York, 37 F.4th 797, 806 (2d Cir. 2022)).
When deciding whether a particular “right” was clearly established, a court must take care not to define the right in terms that are too abstract or at too high a level of generality. See Horn, 11 F.4th at 169. To the contrary, because it is sometimes difficult for one to understand how legal doctrine may apply to particular facts, a court must identify the right at issue with an appropriate level of specificity that is particularized to the facts of the case. Ibid. This is not to say that there must be a prior case involving identical facts or that is directly on point, so long as existing precedent makes clear beyond reasonable debate that what the defendant was doing violated the plaintiff's then-recognized constitutional rights. Ibid.
To decide whether any particular legal rule was clearly established at the time of the alleged conduct, courts in the Second Circuit look to decisions of the U.S. Supreme Court as well as decisions of the Second Circuit, and they may also consider decisions from other federal circuit courts. Ibid. If these appellate-level decisions either dictated or clearly foreshadowed a conclusion that a defendant's actions violated a plaintiff's constitutional rights as defined at the appropriate level of specificity, then this defeats a defense of qualified immunity. Ibid. On the other hand, if there is uncertainty-that is, no clearly established law that would have apprised every objectively reasonable official in the defendant's position that they were violating the plaintiff's constitutional rights-then the defendant is entitled to qualified immunity.
Courts have discretion to uphold a qualified immunity defense without deciding in the first instance if a defendant actually violated the plaintiff's rights. See Pearson v. Callahan, 555 U.S. 223, 236 (2009); Bangs v. Smith, 84 F.4th 87, 96 (2d Cir. 2023). That is, a court may assume for summary judgment purposes that a plaintiff has established a genuine fact issue to show that the defendant violated the plaintiff's rights, but still that the plaintiff's claims must fail because the record does not further show that any objectively reasonable person in the defendant's position would have known that they were violating the plaintiff's rights.
Even so, a court must continue to assess the factual record in the light most favorable to the non-moving party when deciding if a defendant is entitled to qualified immunity. See Tolan, 572 U.S. at 657. Thus, as the Second Circuit has instructed, “[s]ummary judgment should not be granted on the basis of a qualified immunity defense premised on an assertion of objective reasonableness unless the defendant shows that no reasonable jury, viewing the evidence in the light most favorable to the [p]laintiff, could conclude that the defendant's actions were objectively unreasonable in light of clearly established law.” Husain v. Springer, 494 F.3d 108, 131 (2d Cir. 2007); see also Farid v. Ellen, 593 F.3d 233, 244 (2d Cir. 2010) (same).
Turning now to the application of all these legal principles to the facts of this case, it is apparent that the defendants are entitled to qualified immunity from Wang's claim against the use and continuing use of four-point restraints. To be sure, this is not to suggest the absence of any factual disputes. Most significantly, the defendants insist Wang was physically assaultive and verbally threatening, while Wang insists he was not. Because there is clearly a genuine issue of fact on these aspects of Wang's conduct, I assume for purposes of this ruling that Wang was not physically assaultive and that he did not verbally threaten to harm anyone, as he claims.
Still, the remaining facts that are not in legitimate dispute are enough on their own and independently to compel a judgment on qualified immunity grounds in the defendants' favor. To begin, the defendants knew that Wang suffered from schizophrenia, a mental disease characterized by disorganized thought processes, suspicion, and delusion. The defendants also knew that Wang was vehemently opposed to the execution of the state court's order for the involuntary administration of antipsychotic medication. Even after appearing in court on the morning of February 22, 2017, and knowing that all his appeals had been exhausted and that the order would now go into effect, Wang continued to oppose the defendants' execution of the order when he was returned to Whiting. Dr. Kurlyandchik afforded Wang a choice at the outset to take the Olanzapine orally, but instead Wang insisted on being physically carried by medical staff to the treatment room so that the Olanzapine would have to be administered by intramuscular injection.
Wang himself admits that he said, “I will protect myself.” Although this statement was not an explicit verbal threat to harm someone, it unquestionably raised the prospect that Wang could strike out or assault staff who attempted to carry out the state court's medication order that he adamantly opposed. No reasonable jury could conclude that it was objectively unreasonable for a medical professional in Dr. Kurlyandchik's position to conclude, as she did at 2:45pm, that the use of four-point restraints was warranted to ensure the protection of Whiting staff members.
The same was true at 4:45pm when Dr. Dreisbach re-authorized the four-point restraints. The undisputed facts show that Wang yelled at that time that he did not want to talk and that he made vitriolic and mentally unstable statements: “I'm not crazy. You're crazy. I don't need med; you need med. I've Chinese Government behind me. I'll sue you.” More significantly still, Wang refused to assure Dr. Kurlyandchik that he would not assault someone if he were released from the restraints. In light of Wang's statements and his refusal to give an assurance that he would not assault someone if he were released, no reasonable jury could conclude that it was objectively unreasonable for Dr. Dreisbach to have re-authorized the restraints.
Wang argues he thought that Dr. Kurleyandchik's query about whether he would assault someone was a “trap” and that his answering it “would indicate he had wanted to physically harm others earlier.” But the relevant issue for purposes of qualified immunity is not what Wang himself meant or intended. The relevant issue is whether it was objectively unreasonable for a medical professional to interpret Wang's refusal to provide an assurance to mean that he presented an ongoing risk of assault to Whiting staff members if he were released from the four-point restraints.
Doc. #288 at 49.
As the afternoon wore on into the evening and late nighttime, the record similarly and conclusively establishes that it was not objectively unreasonable at each subsequent two-hour checkpoint for Dr. Dreisbach to continue the use of the restraints. When Dr. Dreisbach reauthorized the restraints at 6:45pm, she knew that Wang had yelled that “there is nothing wrong with me,” that he was angry and agitated, that he was threatening to sue staff, and that he was otherwise refusing to engage with staff. When Dr. Dreisbach again re-authorized the restraints at 8:45pm, Wang remained uncooperative, refusing to open his eyes or to discuss his need for restraints, and he was angry and irritable. And when Dr. Dreisbach again re-authorized the restraints at 10:45pm, Wang remained agitated. Wang was released from the four-point restraints at 12:45am when he calmed down and assured one of the nurses that he could follow instructions and was neither homicidal nor suicidal.
In short, as to both Dr. Kurlyandchik and Dr. Dreisbach, the undisputed facts are enough to show that no reasonable jury could conclude that it was objectively unreasonable for the doctors to have kept Wang in restraints for the protection of Whiting staff members (even crediting Wang's claims that he did not engage in physically assaultive conduct or make any explicit verbal threats to harm anyone). Therefore, both Dr. Kurlyandchik and Dr. Dreisbach are entitled to qualified immunity from the claim that they violated Wang's rights by authorizing the initial and continuing use of four-point restraints.
The same goes for the three nurse defendants (Mejias, Delciampo, and Madison) who Wang alleges were complicit with the doctors in restraining him. Wang does not show that the nurse defendants used any force beyond that which was authorized by the orders of Dr. Kurlyandchik and Dr. Dreisbach. Although Wang accuses the nurses of falsely claiming in their progress monitoring notes that he made threats and engaged in physically assaultive conduct, I have not-for reasons explained above-credited any of the facts proffered by the defendants that Wang made such explicit verbal threats or engaged in physically assaultive conduct. I have relied instead on other conduct of Wang that is either not disputed or subject to reasonable dispute.
Therefore, the allegedly false notes or reports made by the nurse defendants makes no difference to the evaluation based on the undisputed facts whether a jury could conclude that it was objectively unreasonable for the restraints to be used as they were. So the nurse defendants-like the doctor defendants-are entitled to qualified immunity.
The parties do not cite any case law saying that the only way for a patient to be shown to pose a risk of harm is if the patient engages in physically assaultive conduct or makes explicit verbal threats to harm people. Instead, as far as I am aware, a mental health professional may consider the totality of circumstances to decide if a mental health patient poses a risk of harm that warrants the imposition of protective measures such as physical restraints. Cf. Anthony v. City of New York, 339 F.3d 129, 142 (2d Cir. 2003) (Sotomayor, J.) (affirming grant of summary judgment in favor of hospital from plaintiff's claim of involuntary commitment and involuntary administration of antipsychotic medication, noting that “the hospital staff had reasonable grounds to believe that [plaintiff] was a danger to herself or to others” where “records from [plaintiff's] examinations by hospital staff demonstrate that they found her initially ‘unresponsive,' and subsequently ‘delusional' and ‘paranoid'”).
My conclusion that the doctor and nurse defendants are now entitled to qualified immunity is not inconsistent with my conclusion that they were not entitled to qualified immunity when I previously denied the defendants' motion to dismiss. See Wang, 664 F.Supp.3d at 221-22. At that time, I rejected the defendants' misguided effort to smuggle their own factual versions of the events into the record at the pleadings stage of the litigation, and I ruled that there were no proper grounds at the pleadings stage to call into question Wang's allegations that he was subject to four-point restraints despite not posing any risk of harm to Whiting staff. See id. at 215-19.
Now, however, with the benefit of a proper summary judgment record, there are ample evidentiary grounds to show that no reasonable jury could conclude that it was objectively unreasonable for Wang to be restrained as he was. Therefore, the defendants would not have necessarily known that it would violate Wang's right to be free from the use of excessive force for him to be placed in and remain in four-point restraints for the ten-hour period from 2:45pm to 12:45am. Accordingly, the defendants have carried their burden to show that they are entitled to qualified immunity from Wang's excessive force claim arising from the use of four-point restraints.
Involuntary administration of Benadryl
Wang further claims that Dr. Dreisbach and two of the nurses (Clara Mejias and Judy Hall) violated his rights when they administered Benadryl without his consent. The Due Process Clause of the Fourteenth Amendment protects both a right to “substantive” due process and “procedural” due process. See County of Sacramento v. Lewis, 523 U.S. 833, 845-46 (1998). Substantive due process generally protects against the government's deprivation of a life, liberty, or property interest in an arbitrary manner or “without any reasonable justification in the service of a legitimate governmental objective.” Id. at 846. By contrast, procedural due process protects the right of a person to receive a fair procedure in connection with the government's deprivation of a life, liberty, or property interest. See Swarthout v. Cooke, 562 U.S. 216, 219 (2011) (per curiam).
Wang's claim against the involuntary administration of Benadryl may be understood to implicate both substantive and procedural due process. It implicates substantive due process to the extent that Wang contends that the defendants had no legitimate medical or governmental need to forcibly medicate him with Benadryl. It implicates procedural due process to the extent that Wang complains that the defendants did not have an authorizing court order or use additional procedures before forcibly medicating him with Benadryl.
It is well-established that “[t]he forcible injection of medication into a nonconsenting person's body represents a substantial interference with that person's liberty.” United States v. Hardy, 724 F.3d 280, 295 (2d Cir. 2013) (citing Washington v. Harper, 494 U.S. 210, 229 (1990)). A detainee “who has not been convicted of a crime has no lesser right” to “avoiding the unwanted administration” of medication. Ibid.
Still, the right to avoid unwanted medication is not absolute: “[t]he right of a prisoner or a detainee to avoid involuntary medication ... may be outweighed by competing governmental interests, such as the interest of prison administrators in ensuring the safety of prison staffs and administrative personnel.” Ibid. Indeed, “[t]here is a ‘legitimate governmental interest in' the involuntary medication of an inmate ‘where medically appropriate for the purpose of reducing the danger he poses.'” Ibid. (quoting Harper, 494 U.S. at 226).
And, again, the Supreme Court's decision in Youngberg v. Romeo counsels deference to the decisionmaking of medical professionals. “[L]iability may be imposed only when the decision by the professional 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.” 457 U.S. at 323.
Even viewing the undisputed facts in the light most favorable to Wang and drawing all reasonable inferences in his favor, I conclude that the defendants are entitled to qualified immunity from Wang's claim for the forcible administration of Benadryl. As described in detail above, the undisputed facts show that Dr. Dreisbach ordered the administration of Benadryl as a sedative following several hours in which Wang-despite the use of four-point restraints- continued to fail to cooperate with Whiting staff as they sought to carry out the state court medication order. Wang remained angry, agitated, defiant, and refusing to engage. Wang does not dispute that a medically appropriate and common use of Benadryl is as a sedative in conjunction with the administration of antipsychotic drugs.
In light of all the evolving circumstances late into the evening of February 22, 2017, no reasonable jury could conclude that it was objectively unreasonable for Dr. Dreisbach to conclude that it was appropriate to use Benadryl as a sedative and to potentially shorten the time when Wang could be safely released from four-point restraints. In other words, it was not objectively unreasonable for Dr. Dreisbach to conclude that the use of Benadryl was medically appropriate and reasonably necessary to respond to Wang's ongoing risk to the safety of Whiting staff.
Wang objects that Benadryl was not one of the medications that the state court order authorized the defendants to involuntarily administer. That is true but not controlling or dispositive. As discussed above, the Due Process Clause allows the involuntary administration of a medication if it is medically appropriate for the purpose of reducing the danger that the patient poses and ensuring the protection of institutional staff. See Hardy, 724 F.3d at 295. The Constitution does not impose yet an additional requirement of a prior court order before a medical professional may administer a medication to a dangerous patient without that patient's consent. See, e.g., Anthony, 339 F.3d at 142 (hospital not liable for involuntary administration of antipsychotic medication to patient whom staff reasonably believed to be a danger to herself or to others and notwithstanding lack of prior court order).
Nor does Wang argue that Dr. Dreisbach should have convened a hearing or engaged in some additional administrative process or procedure prior to exercising her professional judgment to prescribe Benadryl. See Hogan v. Carter, 85 F.3d 1113, 1118 (4th Cir. 1996) (en banc) (doctor entitled to qualified immunity from claim that he should have conducted a prior hearing before deciding in an emergency that patient should be subject to a one-time dose of antipsychotic medication); see also Pinkston v. Kuiper, 2023 WL 3255001, at *3-4 (5th Cir. 2023) (per curiam) (no due process violation because of one-time emergency use of antipsychotic medication); Rosa v. Cook, 2022 WL 17415061, at *11 (D. Conn. 2022) (Merriam, J.) (doctor and nurse not liable for emergency involuntary use of three antipsychotic medications without authorization of a prior court order).
No reasonable jury could conclude that it was objectively unreasonable for Dr. Dreisbach to order the administration of Benadryl and to do so in the absence of a prior court order or an additional hearing or other procedures. Because Dr. Dreisbach would not necessarily have known that she was violating Wang's due process rights by ordering staff to administer two doses of Benadryl to him, she is entitled to qualified immunity from Wang's Benadryl claim.
And the same goes for Wang's Benadryl claim against the two additional nurse defendants (Clara Mejias and Judy Hall). Wang does not show that they acted to administer the Benadryl in any manner that was not fully authorized by Dr. Dreisbach's orders. See Roy v. Alicia, 2021 WL 966010, at *6 (because the prescribing doctor was not liable for her involuntary medication order, then the nurse that injected the plaintiff pursuant to the doctor's orders also could not be liable), rep. and rec. adopted sub. nom. Roy v. Laperla, 2021 WL 964135 (N.D.N.Y. 2021). Therefore, the nurse defendants are entitled to qualified immunity from Wang's claim against the involuntary administration of Benadryl.
Dr. Dreisbach has stated that she prescribed Benadryl not only as a sedative but as a prophylaxis against potential side effects of Olanzapine. Because it was not objectively unreasonable for Benadryl to be used for sedative purposes alone, there is no need to address whether Benadryl was also appropriate to redress potential side effects.
In short, even viewing the facts in the light most favorable to Wang and drawing all reasonable inferences in his favor, I conclude that the defendants have carried their burden to show that they are entitled to qualified immunity. An objectively reasonable medical professional in the defendants' positions would not necessarily have known that they were violating Wang's constitutional rights when they subjected him to the prolonged use of four-point restraints and to the involuntary administration of Benadryl. Because the defendants prevail on grounds of qualified immunity, I need not address the defendants' additional argument that they are also entitled to quasi-judicial immunity.
Conclusion
For the reasons stated above, the Court GRANTS the defendants' motion for summary judgment (Doc. #256). The Court further DENIES as moot the plaintiff's motion for an additional hearing (Doc. #328).
The Clerk of Court shall enter judgment in favor of the defendants and close this case.
It is so ordered.