53 F.4th 154
4th Cir.2022Background
- Decedent (26) with diagnosed schizoaffective disorder wandered naked on I-95 after an alleged road incident, boarded a tractor-trailer, and was reported to 911; Santee officers detained him after incoherent, bizarre behavior.
- Orangeburg County deputy placed Decedent in a patrol car; OCEMS was called for "altered mental status." EMT Jamie Givens and paramedic Alison Harmon arrived, recorded vitals, used an ammonia inhalant, and received no verbal responses.
- Givens and Harmon offered Decedent a choice of hospital or jail; when he shook his head no, Deputy Doroski told him he would give him a ride and later left him at a closed gas station around 2:00 a.m. without shoes, ID, or a phone.
- Shortly before 6:00 a.m., Givens’s and Harmon’s crew found Decedent dead, having been struck by traffic; both providers later signed SCDHEC consent orders disciplining their conduct.
- Appellee (Decedent’s representative) sued Givens and Harmon under 42 U.S.C. § 1983 for deliberate indifference in violation of the Fourteenth Amendment; the district court denied qualified immunity, finding genuine factual disputes.
- The Fourth Circuit affirmed, holding that a pretrial detainee’s right to adequate medical care and freedom from deliberate indifference to serious medical needs was clearly established at the time of the incident.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether a pretrial detainee’s right to adequate medical care and freedom from deliberate indifference was clearly established in Sept 2018 | Tarashuk: Yes—law clearly established that officials who ignore serious medical needs violate the Fourteenth Amendment | Givens/Harmon: Law not clearly established as to EMT/paramedic duties here; qualified immunity applies | Held: Yes—precedent gave fair warning; right clearly established |
| Whether Appellants are entitled to qualified immunity at summary judgment given factual disputes | Tarashuk: Disputed facts allow a reasonable jury to find deliberate indifference | Appellants: Qualified immunity appropriate because no clearly established right or they lacked culpable state of mind | Held: Court reviews legal question only; factual disputes remain for district court, but immunity denied at this interlocutory stage on the legal-question of clearly-established law |
| Proper definition of the right (broad medical-right vs. narrow duty to transport/intervene) | Tarashuk: Right is detainee’s right to adequate medical care and freedom from deliberate indifference | Appellants: Right should be narrowly framed as a right to be transported by them or to have them prevent law enforcement custody | Held: Right properly defined—pretrial detainee’s right to adequate medical care and freedom from deliberate indifference; framing it by the precise acts is improper |
| Whether Decedent was a pretrial detainee as a matter of law | Tarashuk: Decedent was detained and thus a pretrial detainee entitled to Due Process protections | Appellants: (raised for first time on appeal) argue he was not a pretrial detainee | Held: Issue forfeited—defendants conceded detainee status below; Court declines to consider new argument on appeal |
Key Cases Cited
- Harlow v. Fitzgerald, 457 U.S. 800 (1982) (qualified immunity standard: officials shielded unless violating clearly established rights)
- Tolan v. Cotton, 572 U.S. 650 (2014) (summary-judgment standards in qualified-immunity context; view facts in light most favorable to nonmoving party)
- Hope v. Pelzer, 536 U.S. 730 (2002) (law can be clearly established by analogous precedent; officials need fair warning)
- Scinto v. Stansberry, 841 F.3d 219 (4th Cir. 2016) (defines right as prisoners’/detainees’ right to adequate medical care and freedom from deliberate indifference)
- Cooper v. Dyke, 814 F.2d 941 (4th Cir. 1987) (officials liable when they ignore indications initial medical treatment was inadequate)
- Gordon v. Kidd, 971 F.2d 1087 (4th Cir. 1992) (pretrial detainees entitled to medical attention; deliberate indifference is clearly established)
- Iko v. Shreve, 535 F.3d 225 (4th Cir. 2008) (failure to provide adequate medical evaluation/decontamination can constitute deliberate indifference)
- Young v. City of Mount Ranier, 238 F.3d 567 (4th Cir. 2001) (pretrial detainees receive at least same protection as convicted prisoners re: medical care)
- Belcher v. Oliver, 898 F.2d 32 (4th Cir. 1990) (Fourteenth Amendment requires officials not be deliberately indifferent to detainees’ serious medical needs)
- Farmer v. Brennan, 511 U.S. 825 (1994) (deliberate indifference standard and prison officials’ duty to protect inmates)
- Kisela v. Hughes, 138 S. Ct. 1148 (2018) (warning against defining clearly established law too generally in excessive-force contexts)
- City of Escondido v. Emmons, 139 S. Ct. 500 (2019) (similar admonition on specificity in excessive-force cases)
- De'lonta v. Johnson, 708 F.3d 520 (4th Cir. 2013) (some treatment does not necessarily equal constitutionally adequate treatment)
- Heyer v. U.S. Bureau of Prisons, 849 F.3d 202 (4th Cir. 2017) (providing some treatment does not foreclose deliberate-indifference claim)