Dominick Perniciaro, III v. Hampton Lea
901 F.3d 241
5th Cir.2018Background
- Dominick Perniciaro III, a schizophrenic who had been found incompetent to stand trial and later NGRI, was confined at Eastern Louisiana Mental Health System (ELMHS) and suffered multiple physical injuries during his commitments.
- Tulane-employed psychiatrists Dr. Jeffrey Nicholl (treating psychiatrist) and Dr. John Thompson (chief of staff) provided psychiatric services at ELMHS under a state contract; Hampton “Steve” Lea was ELMHS CEO and a state employee.
- Perniciaro alleges § 1983 claims: failure to protect him from harm and constitutionally inadequate medical care; defendants moved for summary judgment on qualified-immunity grounds.
- ELMHS policy favored limiting physical restraints and used arm’s-length observation (ALO) or close-visual observation (CVO); Nicholl adjusted observation levels and medications in response to incidents.
- The district court allowed the Tulane doctors to invoke qualified immunity but denied summary judgment on fact disputes; the Fifth Circuit reviewed whether, on the record viewed favorably to Perniciaro, defendants violated clearly established rights.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether Tulane-employed psychiatrists may assert qualified immunity | Tulane doctors are private contractors and cannot claim state-actor immunity | They acted within a state-run facility under state supervision and thus may claim qualified immunity | Drs. Nicholl and Thompson may assert qualified immunity (Filarsky framework) |
| Whether defendants violated due process by failing to protect Perniciaro from violence | Perniciaro: defendants were deliberately indifferent / substantially departed from professional judgment given repeated injuries and known violence | Defendants: they monitored, adjusted observation, changed meds, and reasonably responded to risks; many incidents showed Perniciaro was aggressor | No clearly established violation shown; qualified immunity applies to defendants on failure-to-protect claim |
| Whether defendants provided constitutionally adequate medical care for shoulder and psychiatric treatment | Perniciaro: medical care was inadequate; alternative treatments (other antipsychotic, ECT) not pursued; inadequate holistic plan | Defendants: medical/orthopedic evaluations, imaging, referrals, pain management and conservative treatment were provided; disagreements over treatment are medical judgment | Dispute over treatment does not establish deliberate indifference; no clearly established violation; qualified immunity applies |
| Whether supervisory liability attaches to Thompson and Lea for training/supervision/reporting failures | Perniciaro: supervisors failed to train/supervise, causing constitutional violations | Defendants: no underlying constitutional violation proven; no specific training deficiencies or causal link shown | Supervisory liability requires an underlying violation and specific causal notice; none proven—Thompson and Lea entitled to qualified immunity |
Key Cases Cited
- Filarsky v. Delia, 566 U.S. 377 (2012) (private individuals temporarily serving governmental functions may claim qualified immunity when historical and purposive tests support it)
- Richardson v. McKnight, 521 U.S. 399 (1997) (consideration of purposes of immunity for private prison guards)
- Youngberg v. Romeo, 457 U.S. 307 (1982) (professional-judgment standard for care and safety of involuntarily committed persons)
- Hare v. City of Corinth, 74 F.3d 633 (5th Cir. 1996) (deliberate-indifference standard applied to pretrial detainees for failure-to-protect and medical-care claims)
- Farmer v. Brennan, 511 U.S. 825 (1994) (deliberate indifference requires subjective awareness of substantial risk and unreasonable disregard)
- Ashcroft v. al-Kidd, 563 U.S. 731 (2011) (qualified immunity requires violation of clearly established law; avoid overbroad generalizations)
- Mullenix v. Luna, 136 S. Ct. 305 (2015) (focus on whether particular conduct was clearly established unlawful)