De Paz Gonzalez v. Duane, 4:20-cv-00072

Background

On March 29–31, 2018 Berman DePaz-Martinez suffered catastrophic brain injuries and was intubated and ventilated at John Peter Smith Hospital; his family communicated (through an interpreter) that they wanted continued treatment and believed in miracles.
Medical staff categorized Berman DNR-A and discussed poor prognosis; multiple clinicians assessed his injuries as non-survivable.
On April 1, 2018 Dr. Theresa Duane concluded Berman met clinical extubation parameters (including RSBI of 67 and intact cough/gag reflex), ordered extubation, and did not seek family consent, believing extubation was medically indicated to reduce complications of prolonged intubation.
Berman became hypoxic and died shortly after extubation; the medical examiner listed blunt force head trauma from the fall as the cause of death.
Plaintiffs (parents) sued Duane under 42 U.S.C. § 1983 alleging intentional euthanasia and deprivation of life without due process; claims against the hospital district and Duane’s employer were dismissed and estate claims were withdrawn, leaving only parents’ survivor § 1983 claims.
The court granted Duane summary judgment, finding no genuine dispute that extubation was a medical treatment decision, that Berman’s injuries were non-survivable, plaintiffs offered no expert proof to controvert Duane, and Duane is entitled to qualified immunity.

Issues

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether extubation required pre-deprivation due process (notice/hearing)	Duque[DePaz plaintiffs] contend Duane unilaterally removed life support without consent, violating procedural due process	Duane contends extubation was a routine medical treatment decision once clinical parameters were met and did not require family permission	Court: No due-process violation shown — evidence shows a medical judgment to extubate, not a deliberate decision to kill, and plaintiffs offered no expert to controvert that judgment
Causation / survivability for survivor damages under § 1983	Plaintiffs assert extubation caused Berman’s death and thus survivor damages are available	Duane and record show multiple clinicians deemed injuries non-survivable; extubation was consistent with reducing intubation risk	Court: Berman’s injuries were non-survivable; plaintiffs failed to show Duane caused death or lost-chance recovery — survivor damages fail
Punitive/exemplary damages (state & § 1983) — requisite culpability	Plaintiffs argue conduct was intentional or recklessly indifferent to constitutional rights, supporting punitive damages	Duane argues lack of subjective evil intent or conscious recklessness; action was medically reasonable	Court: Plaintiffs produced no probative evidence of subjective malice/recklessness; punitive damages not supported
Qualified immunity for a physician acting under color of state law	Plaintiffs argue a clearly established right required process before removing life support	Duane argues she acted within medical discretion; reasonable physicians could differ; qualified immunity applies	Court: Duane entitled to qualified immunity — no clearly established precedent required seeking permission to extubate under these facts and her conduct was objectively reasonable

Key Cases Cited

Harlow v. Fitzgerald, 457 U.S. 800 (1982) (standard for qualified immunity)
Anderson v. Creighton, 483 U.S. 635 (1987) (clearly established-law requirement)
Malley v. Briggs, 475 U.S. 335 (1986) (objective reasonableness in qualified immunity)
Mullenix v. Luna, 577 U.S. 7 (2015) (deference where reasonable officials could differ)
White v. Pauly, 137 S. Ct. 548 (2017) (clearly established law must be particularized to facts)
Estelle v. Gamble, 429 U.S. 97 (1976) (medical-treatment decisions are matters of medical judgment)
Celotex Corp. v. Catrett, 477 U.S. 317 (1986) (summary-judgment burden-shifting principles)
Daniels v. Williams, 474 U.S. 327 (1986) (deliberate decisions to deprive life implicate due process)
Slade v. City of Marshall, 814 F.3d 263 (5th Cir. 2016) (survivor damages under § 1983 require proof that defendant caused death)
Kramer v. Lewisville Mem'l Hosp., 858 S.W.2d 397 (Tex. 1993) (lost-chance doctrine and limits on recovery where preexisting injuries make survival improbable)