Opinion
Civil Action No. 3:03-CV-1612-N.
March 24, 2005
ORDER
Before the Court is Defendants' Motion for Summary Judgment filed on August 13, 2004. The Court grants Defendants' motion, dismissing the section 1983 claims against Dr. Rita Moss, Dallas County and Sheriff Jim Bowles.
I. BACKGROUND
Rosa Alejo, a mental health patient, died in the custody of the Dallas County Jail on March 5, 2002. When Ms. Alejo was booked into the Dallas County Jail on February 16, 2002, she had in her possession prescribed medications to treat her mental illness. Jail staff confiscated those prescriptions and a jail psychiatrist did not see Ms. Alejo until February 26, 2002. Beginning on February 23, 2002, and throughout her eighteen day incarceration, Ms. Alejo exhibited bizarre behavior such as yelling and screaming; scratching herself; and eating toilet tissue, her own feces and coffee grinds, the last of which allegedly contributed to her death associated with caffeine poisoning. At all times during Ms. Alejo's incarceration, Dr. Rita Moss was the chief psychiatrist in charge of supervising the physicians who treated psychiatric patients at the Dallas County Jail. Ms. Alejo's personal representative and her husband (collectively "Ms. Alejo") bring this suit against Dr. Moss, Dallas County and Sheriff Jim Bowles for, inter alia, their violation of 42 U.S.C. § 1983 due to their deliberate indifference to Ms. Alejo's serious medical needs.
II. SUMMARY JUDGMENT AS TO DR. RITA MOSS
Dr. Moss moves for summary judgment as to the deliberate indifference to medical needs claim against her because she was not aware of a substantial risk of harm to Ms. Alejo, Dr. Moss did not act deliberately indifferent to the risk of harm to Ms. Alejo, and because Dr. Moss is entitled to qualified immunity. 42 U.S.C. § 1983 authorizes suits against state and local government officials who violate a person's constitutional rights. In Estelle v. Gamble, the Supreme Court held that the Eighth Amendment's proscription of cruel and unusual punishments forbids jail officials to be deliberately indifferent to inmates' serious medical needs because such indifference is itself cruel and unusual punishment. 429 U.S. 97, 104 (1976). Pretrial detainees like Ms. Alejo also have a right to be free from jail officials' deliberate indifference to their serious medical needs. Hare v. City of Corinth, MS, 74 F.3d 633, 643 (5th Cir. 1996) (en banc). This right springs from both procedural and substantive due process and is at least as great as that mandated by the Eighth Amendment. Id; see also Bell v. Wolfish, 441 U.S. 520, 535 (1979). To establish a violation of this right, an inmate must show that she was subjected to a substantial risk of serious harm. The inmate must also prove that the jail official was subjectively aware of facts from which an inference could be drawn that a substantial risk of serious harm existed and then actually drew such an inference. Farmer v. Brennan, 511 U.S. 825, 837 (1994); Harris v. Hegmann, 198 F.3d 153, 159 (5th Cir. 1999). Finally, the inmate must establish that the jail official's response to the perceived risk of harm shows that official's deliberate indifference. Farmer, 511 U.S. at 844-45.
Ms. Alejo argues that the facts in this case demonstrate that Dr. Moss was aware of a substantial risk of harm to Ms. Alejo. Ms. Alejo refers repeatedly to facts that various jail staff knew. For example, Ms. Alejo claims that officers repeatedly witnessed Ms. Alejo eat coffee grinds and that this behavior presented a serious risk of harm, especially in light of the fact that Ms. Alejo's death was associated with caffeine toxicity. However, Ms. Alejo herself admits that no incident of coffee eating was ever listed in the psychiatric chart or notes or otherwise reported to Dr. Moss, and fails to establish any fact showing that Dr. Moss was aware of this behavior. The summary judgment evidence shows that Dr. Moss was aware of only portions of Ms. Alejo's bizarre behavior, including Ms. Alejo's yelling, screaming, pulling her hair, attempting to flood her cell, and eating her toilet tissue and feces.
The summary judgment record, however, further shows that Dr. Moss knew that Nurse McClellan had seen Ms. Alejo on February 16, 2002; that a mental health caseworker named Williams had seen Ms. Alejo the next day; that Ms. Alejo had received an injection of Haldol-D, a long lasting medication on February 11, 2002, and that no further dose should have been necessary until March 10, 2002; and that Dr. Clayton had seen Ms. Alejo on February 26, 2002, and had prescribed Zyprexa 10 mg. to treat Ms. Alejo's aberrant behavior. Taking this additional knowledge into account, Ms. Alejo has not established that Dr. Moss was aware of a substantial risk of harm to Ms. Alejo.
Ms. Alejo also contends that Dr. Moss responded to the substantial risk of harm with deliberate indifference. The summary judgment record shows that Dr. Moss responded to Ms. Alejo's needs by giving the medical staff a standing order to administer 10 mg. injections of Haldol as needed to control Ms. Alejo's behavior. Furthermore, Dr. Moss monitored the medical staff's treatment as described above. These facts do not demonstrate Dr. Moss' deliberately indifferent response to Ms. Alejo's medical needs.
In attempting to prove both Dr. Moss' awareness of a substantial risk and Dr. Moss' deliberately indifferent response to that risk, Ms. Alejo relies heavily on her medical expert, Dr. Reid. Dr. Reid's affidavit provides his opinion as to the standard of care and how it was breached in this case. While Dr. Reid's opinion is relevant to the reasonableness standard that is the centerpiece of any medical malpractice claim, his opinions do nothing to inform the Court regarding the alleged constitutional violation at issue here. Dr. Reid can tell us nothing about what Dr. Moss actually knew about Ms. Alejo's behavior or whether Dr. Moss deliberately ignored Ms. Alejo's medical needs. Thus, Ms. Alejo has failed to demonstrate that Dr. Moss knew of a substantial risk of harm to Ms. Alejo or that Dr. Moss' response to Ms. Alejo's medical needs was deliberately indifferent. Because there is no issue of fact as to Dr. Moss' culpability for a constitutional violation, the Court need not address Dr. Moss' qualified immunity argument. Nunez v. Simms, 341 F.3d 385, 387 (5th Cir. 2003). Accordingly, Dr. Moss is granted summary judgment as to the denial of medical treatment claim.
III. SUMMARY JUDGMENT AS TO DALLAS COUNTY AND SHERIFF JIM BOWLES
Dallas County and Sheriff Jim Bowles (collectively "Dallas County") move for summary judgment on the grounds that there is no evidence that any county policy was adopted or continued with deliberate indifference or that any such policy caused a deprivation of Ms. Alejo's federal rights. A local government entity such as a county may not be held liable under 42 U.S.C. § 1983 under a theory of respondeat superior. Monell v. Dep't of Soc. Servs., 436 U.S. 658, 693 (1978); Johnson v. Deep E. Tex. Reg'l Narcotics Trafficking Task Force, 379 F.3d 293, 308 (5th Cir. 2004). Rather, liability for a county under section 1983 requires a plaintiff to identify a policymaker's specific unconstitutional action or county policy. Bd. of the County Comm'rs v. Brown, 520 U.S. 397, 403 (1997); Johnson, 379 F.3d at 309. A policy may be one of two types:
Because Ms. Alejo's claim against Sheriff Jim Bowles in his official capacity is a claim against the county that employs him, granting summary judgment for Dallas County also grants summary judgment as to Sheriff Jim Bowles. See Kentucky v. Graham, 473 U.S. 159, 165 (1985).
1. A policy statement, ordinance, regulation, or decision that is officially adopted and promulgated by the [local government's] lawmaking officers or by an official to whom the lawmakers have delegated policy-making authority; or
2. A persistent, widespread practice of [local government] officials or employees, which, although not authorized by officially adopted and promulgated policy, is so common and well settled as to constitute a custom that fairly represents [local government] policy. Actual or constructive knowledge of such custom must be attributable to the governing body of the [local government] or to an official to whom that body had delegated policy-making authority.Johnson, 379 F.3d at 309 (internal cites omitted). For the sake of brevity, the Court will refer to the first type as "policies" and the second type as "customs."
In addition, a plaintiff must prove either that the policy or custom itself is facially unconstitutional, Brown, 520 U.S. at 404-05 (1997); Johnson, 379 F.3d at 309, or that the policy was adopted or maintained by the county's policymakers with deliberate indifference as to its known or obvious consequences. City of Canton v. Harris, 489 U.S. 378, 391-92 (1989); Johnson, 379 F.3d at 309. When relying on the second or "deliberate indifference" theory of liability, a plaintiff must prove: (1) that the policy or custom was the "moving force" behind the violation of the plaintiff's rights, Piotrowski v. City of Houston, 237 F.3d 567, 578 (5th Cir. 2001) (citing Monell, 436 U.S. at 694); and (2) that the policy or custom was adopted or maintained with deliberate indifference to the known or obvious fact that such constitutional violations would result. Johnson, 379 F.3d at 309. This second element "generally requires that a plaintiff demonstrate at least a pattern of similar violations." Id. (collecting cases).
Defendants admit that Sheriff Bowles is the appropriate policymaker for the Dallas County Jail. See Williams v. Kaufman County, 343 F.3d 689, 709 (5th Cir. 2003).
Ms. Alejo identifies six explicit policies (as opposed to customs) that she claims can be the basis for Dallas County's liability. The last three policies Ms. Alejo identifies in her response to the instant motion cannot be the basis for Dallas County's liability because in each instance, Ms. Alejo claims that jail staff violated the policies at issue. Where the staff violates a policy, such violation is the moving force behind any deprivation of rights rather than the policy itself and, consequently, there is no basis for the county's liability. See Evans v. City of Marlin, Texas, 986 F.2d 104, 108 n. 6 (5th Cir. 1993). Otherwise, a county's liability would be impermissibly premised on respondeat superior. See Brown, 520 U.S. at 403 (1997). For example, Ms. Alejo claims that Dallas County inmate classification policy required that "[i]nmates who . . . are suspected of being mentally ill shall be separated from other inmates." Ms. Alejo goes on to claim that jail staff blatantly disregarded this policy and did not separate Ms. Alejo as required. Accordingly, the identified policy itself was not the moving force behind any alleged violation of Ms. Alejo's rights and cannot support Dallas County's liability.
Furthermore, Ms. Alejo does not claim that such violation of the official segregation policy had itself become a custom and that this custom somehow violated Ms. Alejo's rights.
Ms. Alejo also identifies three other explicit Dallas County policies that she claims will support Dallas County's liability. The first is that Dallas County Jail provides only two methods for an inmate needing medical attention to receive such attention: (1) the inmate may make an unequivocal request for medical treatment, or (2) if an officer observes a medical problem that requires immediate medical treatment, he must transport the inmate to medical staff. Ms. Alejo claims that inmates situated as she was are unable to make unequivocal requests for treatment. Ms. Alejo seems to argue that the jail's policy is facially unconstitutional because the Constitution requires appropriate medical attention for serious medical needs while the jail's policy of only providing attention for emergent medical issues would result in at least delay of treatment until an allegedly serious need became immediate. See Estelle v. Gamble, 429 U.S. 97, 104-05 (1976) (holding that denying or even delaying treatment for serious medical needs violates the Eighth Amendment). However, the jail's policy is not facially invalid because it is possible to apply the policy without violating the Constitution. See generally United States v. Salerno, 481 U.S. 739, 745 (1987) (holding that laws are facially unconstitutional only if "no set of circumstances exists under which the Act would be valid."). Ms. Alejo's position relies on equating "immediate" with "emergency." But jail staff quite possibly could consider a serious medical need as requiring immediate attention. Accordingly, this policy is not facially unconstitutional.
Second, Ms. Alejo argues that the policy of requiring officers to transport inmates only when they need immediate treatment was instituted or maintained in deliberate indifference to the rights of inmates. Dallas County responds that there is no evidence that this policy was the moving force behind any deprivation of Ms. Alejo's rights and that there is no evidence of Sheriff Bowles' deliberate indifference. The Court agrees that there is no evidence that this policy in any way motivated any delay or denial of medical care to Ms. Alejo. Ms. Alejo has produced no summary judgment evidence to show that jail staff failed to transport or otherwise initiate the treatment process because they did not consider Ms. Alejo's serious condition immediate.
Furthermore, proof of deliberate indifference in instituting or maintaining the jail's policy on medical treatment generally requires evidence of prior similar incidents, putting the Sheriff on notice that constitutional violations could occur. See Johnson, 379 F.3d at 309. Here, Ms. Alejo relies exclusively on her own eighteen day incarceration. Ms. Alejo has produced no summary judgment evidence that Sheriff Bowles was deliberately indifferent to the serious medical needs of inmates. The Court is aware of recent news articles questioning the quality of medical services the Dallas County Jail provides to its inmates. See, e.g., James M. O'Neill, Heart Patient's Family Sues, Says Jail Didn't Give Medical Care, DALLAS MORNING NEWS, March 17, 2005, at 1A. However, in responding to Dallas County's motion for summary judgment, Ms. Alejo produced no evidence of previous similar occurrences or any other fact to show Sheriff Bowles was aware that constitutional violations could occur as a result of his policies. Accordingly, Dallas County is entitled to summary judgment as to this policy.
Third, Ms. Alejo argues that jail policy that limits seeing a psychiatrist to one day per week is facially invalid because delay of care violates the Constitution. See Estelle, 429 U.S. at 104-05. This policy is not facially invalid because in many circumstances weekly psychiatric consultations would be perfectly appropriate and constitutional. See generally Salerno, 481 U.S. at 745. This policy must also be read in conjunction with the policy requiring officers to transport inmates needing immediate medical attention to medical staff. The former policy addresses mental health needs appropriately addressed on a weekly basis and the latter policy addresses more emergent needs. Accordingly, this policy is not facially unconstitutional.
Ms. Alejo also argues that this policy was instituted and maintained in deliberate indifference to inmates' serious medical needs. Once again, Ms. Alejo has produced no evidence that the jail staff ever delayed or deprived Ms. Alejo of medical treatment in reliance on the once-a-week psychiatrist visit policy or that Sheriff Bowles was aware that this policy could cause constitutional violations. Accordingly, Dallas County is entitled to summary judgment as to this policy.
Finally, Ms. Alejo claims that Dallas County jail had a policy requiring certain paperwork when an inmate refuses medical treatment, as Ms. Alejo did on at least one occasion. Ms. Alejo merely states that this policy was inadequate. As above, Ms. Alejo provides no evidence to support either causation or deliberate indifference. Accordingly, Dallas County is entitled to summary judgment as to this policy.
IV. CONCLUSION
This case presents a tragic series of events for Ms. Alejo and her family. The Court is certainly sympathetic to the plight of the plaintiffs in this case. However, Ms. Alejo failed to meet her summary judgment burden as to her section 1983 claims. Accordingly, Defendants' Motion for Summary Judgment is granted. In accordance with Fifth Circuit teaching, the Court declines to exercise jurisdiction over Ms. Alejo's state law claims. See Parker Parsley Petroleum Co. v. Dresser Indus., 972 F.2d 580, 585 (5th Cir. 1992).