13 F.4th 729
9th Cir.2021Background
- Coston, a California state prisoner with chronic pain, was prescribed morphine under a required Direct Observation Therapy (DOT) protocol.
- Correctional officer found large quantities of morphine pills in Coston’s cell; officers confiscated pills and disciplined Coston.
- Dr. Nangalama terminated Coston’s morphine prescription without tapering and did not examine or test Coston before doing so; Coston later exhibited withdrawal symptoms and repeatedly complained of severe pain.
- Prison medication-management policy required DOT and set alternative procedures for noncompliance; the district court excluded that policy from evidence at trial.
- At retrial the district court gave a Ninth Circuit “deference” (Norwood) jury instruction to defer to prison-security judgments; jury returned verdict for defendants.
- Ninth Circuit held the deference instruction was erroneous under these facts, found the error not harmless, vacated the judgment, and remanded for a new trial.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether the jury should have been given a deference (Norwood) instruction | Deference improper because no plausible connection between a security-based policy and the decision to abruptly stop morphine; evidence shows DOT was not followed | Deference appropriate; courts should defer to prison officials on security-related medical decisions | Instruction improperly given: no plausible connection shown here, so instruction was erroneous |
| Admissibility/relevance of the prison medication-management policy | Policy was relevant: it required DOT and provided alternatives, undermining security-justification | Policy irrelevant to the Eighth Amendment claim | Policy was relevant and its exclusion was erroneous (supports plaintiff’s position) |
| Whether the instructional error was harmless | Instruction was prejudicial given strong evidence that DOT wasn’t followed and less drastic alternatives existed | Any error was harmless and would not have changed verdict | Error was not harmless; Norwood instruction can substantially bias jury—reversal and remand required |
| When deference instructions are permissible in prison medical cases | Deference only when the defendant plausibly ties the challenged medical decision to a security-based policy and the response is not unnecessary, unjustified, or exaggerated; jury must decide applicability | Deference may be routinely given to prison officials’ security judgments | Court limited use of deference instructions: require a plausible connection and leave the decision whether to defer to the jury; deference inappropriate in this trial |
Key Cases Cited
- Edmo v. Corizon, Inc., 935 F.3d 757 (9th Cir. 2019) (Eighth Amendment deliberate-indifference standard for prison medical care)
- Norwood v. Vance, 591 F.3d 1062 (9th Cir. 2010) (origin of the Ninth Circuit "deference" instruction addressed in this opinion)
- Chess v. Dovey, 790 F.3d 961 (9th Cir. 2015) (explains limits on routinely giving deference instructions in prison medical cases)
- Shorter v. Baca, 895 F.3d 1176 (9th Cir. 2018) (clarifies harmless-error standard and cautions about deference instruction’s prejudice)
- Mendiola-Martinez v. Arpaio, 836 F.3d 1239 (9th Cir. 2016) (instructs that jury must decide whether deference applies if response was exaggerated)
- Harrington v. Scribner, 785 F.3d 1299 (9th Cir. 2015) (comments on the substantial prejudicial effect of Norwood instruction)
- Clem v. Lomeli, 566 F.3d 1177 (9th Cir. 2009) (harmless-error standard for jury-instruction errors)