Patrick Russell v. Jocelyn Lumitap, 31 F.4th 729

Background:

Pretrial detainee Patrick Russell presented repeatedly (Jan 23–24, 2016) with severe chest pain, vomiting, hyperventilation, numbness, and worsening distress; he ultimately became unresponsive and died of an aortic dissection.
Nurse Trout gave an initial dose of nitroglycerin (~1:08 a.m.) that did not relieve pain; she consulted on-call physician Dr. Le by phone, who recommended Motrin and mental-health screening; Dr. Le never examined Russell in person.
Over the next 11+ hours Russell was evaluated multiple times by Nurses Teofilo and Lumitap; his condition deteriorated but paramedics were not called until he was unresponsive (~12:20 p.m.), and he died after transport.
Plaintiffs sued under 42 U.S.C. § 1983 for deliberate indifference to serious medical needs; district court denied qualified immunity to the medical staff; defendants appealed interlocutorily on qualified immunity grounds.
The Ninth Circuit applied the objective deliberate-indifference framework (as articulated in Gordon and applied via Sandoval for pre-Gordon incidents) to decide whether existing precedent made the unlawfulness clearly established at the time.

Issues:

Issue	Plaintiff's Argument	Defendant's Argument	Held
1) Applicable constitutional standard and scope of review for qualified immunity	Pretrial-detainee inadequate-medical-care claims require objective deliberate-indifference analysis; appellate review may decide legal question assuming plaintiff-favorable facts	Defendants argued interlocutory appeal improper or that facts create jury questions precluding clear-established-law finding	Court held objective Gordon-style test applies and it has jurisdiction to decide qualified immunity de novo on plaintiff-favorable record
2) Whether Dr. Le violated clearly established rights by relying on a phone evaluation and not hospitalizing/examining Russell after ineffective nitroglycerin	Dr. Le’s remote refusal to hospitalize and failure to examine an obviously worsening patient was constitutionally inadequate and clearly established	Dr. Le argued phone assessment and following his medical judgment shielded him; no controlling precedent made his conduct clearly unlawful	Qualified immunity denied for Dr. Le — reasonable jury could find his conduct violated clearly established law
3) Whether Nurse Trout is liable for following Dr. Le’s orders after the ineffective nitroglycerin	Trout’s failure to hospitalize after an ineffective NTG dose contributed to deliberate indifference	Trout promptly called on-call physician and followed his instructions; no clearly established law would have put a reasonable nurse on notice that reliance was unconstitutional	Qualified immunity granted for Nurse Trout — adherence to physician direction insulated her conduct
4) Whether Nurses Teofilo and Lumitap are liable for not calling paramedics or re-contacting a physician as Russell worsened	Both nurses observed worsening, life-threatening symptoms and failed to seek emergent care, amounting to deliberate indifference	They relied on the prior physician recommendation and nursing assessments; argued no clear-established law required different steps under these facts	Qualified immunity denied for Teofilo and Lumitap — triable issues exist whether a reasonable nurse would have acted differently as symptoms worsened

Key Cases Cited

Estelle v. Gamble, 429 U.S. 97 (1976) (Eighth Amendment deliberate indifference to prisoners’ serious medical needs recognized)
Kingsley v. Hendrickson, 576 U.S. 389 (2015) (objective unreasonableness standard for pretrial-detainee excessive-force claims)
Gordon v. County of Orange, 888 F.3d 1118 (9th Cir. 2018) (applies Kingsley objective standard to pretrial-detainee inadequate-medical-care claims)
Sandoval v. County of San Diego, 985 F.3d 657 (9th Cir. 2021) (applies objective deliberate-indifference analysis to pre-Gordon incidents for qualified-immunity review)
Clouthier v. County of Contra Costa, 591 F.3d 1232 (9th Cir. 2010) (former two-part deliberate-indifference framework for conditions-of-confinement claims)
Plemmons v. Roberts, 439 F.3d 818 (8th Cir. 2006) (delay in treating classic heart-attack symptoms can satisfy deliberate indifference)
Tlamka v. Serrell, 244 F.3d 628 (8th Cir. 2001) (failure to continue life-saving treatment without explanation supports liability)
Ortiz v. Imperial, 884 F.2d 1312 (9th Cir. 1989) (unreasonable failure to provide emergent care can constitute deliberate indifference)
Farmer v. Brennan, 511 U.S. 825 (1994) (culpability standards for deliberate indifference and risk assessment)