Susan Liese v. Indian River County Hospital District
701 F.3d 334
| 11th Cir. | 2012Background
- IRMH is a federally funded Florida hospital with a formal policy, Communication Barriers, offering interpreters, MARTTI, and other aids, but staff discretion governs use.
- Lieses, both with severe hearing impairment, visited IRMH’s ER in Nov 2007 seeking an interpreter for Susan and communicate via notes; multiple requests for an interpreter were made.
- Hospital staff primarily used lipreading, notes, and pantomime to convey information about tests and procedures, including an emergency gallbladder surgery for Susan.
- Dr. Perry and other IRMH doctors treated Susan; Susan repeatedly requested an interpreter, which was not provided; doctor’s explanations were often by notes or pantomime.
- Prior Fisher settlement in 2005 required IRMH to train staff and maintain an interpreter list; some training on MARTTI occurred in 2007, but there was no guidance on when to deploy communicative aids.
- District court granted summary judgment to IRMH on some claims and sua sponte reconsidered the RA claim; Lieses appealed asserting violation of §504 of the Rehabilitation Act and related state-law claims; appellant court reversed in part and remanded.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether deliberate indifference is the standard for §504 liability. | Lieses argue deliberate indifference shows discriminatory intent. | IRMH argues either standard; but agrees deliberate indifference applies. | Deliberate indifference is the standard and supports liability. |
| Whether IRMH doctors’ deliberate indifference can be attributed to IRMH under Gebser. | Doctors had authority to provide aids and acted with indifference. | Gebser limits attribution to officials with decision power. | Doctors with supervisory authority could bind IRMH; attribution satisfied. |
| Whether IRMH violated §504 by failing to provide appropriate auxiliary aids. | IRMH failed to provide interpreters/auxiliary aids as needed for treatment. | Providing aids depended on staff discretion; not automatically a violation. | Record could support failure to provide appropriate aids. |
| Whether the district court correctly granted/denied Florida NIED claim and protective order. | NIED claim could survive; protective order wrongly restricted discovery. | No duty to obtain informed consent under Florida law; protective order appropriate. | District court properly granted summary judgment on NIED; protective order affirmed. |
Key Cases Cited
- Gebser v. Lago Vista Indep. Sch. Dist., 524 U.S. 274 (U.S. 1989) (deliberate indifference governs private damages under Title IX/RA)
- guardians Ass’n v. Civil Serv. Comm’n, 463 U.S. 582 (U.S. 1983) (private damages require discriminatory intent under Title VI)
- Barnes v. Gorman, 536 U.S. 181 (U.S. 2002) (Title IX guidance for RA damages; intentional discrimination scope)
- Alexander v. Choate, 469 U.S. 287 (U.S. 1985) (RA purposes and scope; Spending Clause context)
- Duvall v. Cnty. of Kitsap, 260 F.3d 1124 (9th Cir. 2001) (deliberate indifference standard applied to RA/Title II)
- Meagley v. City of Little Rock, 639 F.3d 384 (8th Cir. 2011) (deliberate indifference adopted as standard for RA damages)
- T.W. ex rel Wilson v. Sch. Bd. of Seminole Cnty., 610 F.3d 588 (11th Cir. 2010) (discusses standard for discriminatory intent under RA)
- Wood v. President & Trs. of Spring Hill Coll., 978 F.2d 1214 (11th Cir. 1992) (intentional discrimination concept in RA context)
- Cedars Med. Ctr., Inc. v. Ravelo, 738 So. 2d 362 (Fla. 3d Dist. Ct. App. 1999) (Florida duty to obtain informed consent requirement)
- Yocom v. Wuesthoff Health Sys., Inc., 880 So. 2d 787 (Fla. 5th Dist. Ct. App. 2004) (Florida NIED considerations in medical context)