Dolihite v. Maughon

and the whole, instructions aas Taken plaintiffs’ fairly presented form verdict jury danger that no seeWe claims. or the contentions plaintiffs’

misunderstood estoppel. promissory

requirements

Conclusion. is AF- district judgment of

FIRMED. Individually DOLIHITE, Leroy

Michael Friend Next as Father Dolihite, Mary Dolihite; Joyce Michael Plaintiffs-Appellees, Individually, By Deceased, M.D., MAUGHON,

Robert VIDEON, Ex Mary Fay Through Mau of Robert the Estate

ecutrix Individually; King, M.D.; Royce G. ghon, III, Poundstone, Individual Emmett

R. Individually; Dykes, Anthony R. ly; Individually; Karen Mazick,

Bradley McBride, In individually;

Juris, Andrew M.D.; Jenkins, Med

dividually; Chester Inc., Defen Management, Money

ical

dants-Appellants, Mental Department Alabama Center; Adolescent Health; Eufaula P.C.; Associates, Medi

Neuropsychiatry Inc., Defendants. Management,

cal

No. 94-6343. Appeals, Court States

United Circuit.

Eleventh 23, 1996.

Jan.

1030 Keene,

Thomas H. Nathan Wayne Simms, Jr., Rushton, Stakely, Garrett, Johnston & P.A., AL, Montgomery, for Maughon, Jen- kins, Money Medical Management. Trawiek, G.R. Department “Rick” of Men- tal Health and Retardation, Mental Mont- gomery, AL, King, Poundstone, Dikes, K. Juris, McBride. Philip Gidiere, Jr., S. Carpenter Gidiere, & AL,

Montgomery, Bradley for Dr. Mazick. Kathryn Sumrall, H. Jr., Ezra B. Perry, Ward, James Corley, S. Ward, Moncus & PC, Birmingham, AL, for Michael L. Doli- hite. Tyson,

Fred Rushton, W. Stakely, John- Garrett, ston & Montgomery, AL, for Vi- deon. KRAVITCH, Before ANDERSON and

EDMONDSON, Circuit Judges. ANDERSON, Judge: Circuit appellants § in this 1983 action argue that the district court erred in denying them summary judgment on the qualified basis immunity. We affirm the district court’s de- nial of summary judgment as to one of the appellants, Karen Juris. We reverse the district court’s order as to the remaining appellants; we hold they are entitled to summary judgment qualified on immunity grounds. On February 17,1991, the County Baldwin Court,

Juvenile having adjudged David Doli- hite in supervision, need of ordered David committed to the Eufaula Adolescent Center Money Depart- employ Management, (“Eufaula”), of Medical facility of the Alabama Inc.; director; Anthony Dykes, Mental Retarda- Mental Health and Eufaula’s ment of (“ADMHMR”). Poundstone, was not admitted tion Emmett ADMHMR Associate later, year Janu- almost a Health; Eufaula until Royce for Mental Commissioner years old. ary He was fifteen King, ADMHMR Commissioner. seventy days after his arrival Approximately allege Dolihites that the defen Eufaula, Although hung himself. rights David’s substantive un dants violated resuscitated, injury he sustained he was process due clause the Fourteenth der the severely attempt left him during his suicide Youngberg v. set forth in Ro Amendment brain-damaged. meo, 307, 102 2452, 73 L.Ed.2d 457 U.S. S.Ct. parents, individually, David’s (1982),2 i.e., right reasonably safe (“the father, plaintiffs”), as his next friend confinement, from un conditions freedom brought against § various this 1983 action restraints, bodily such mini professionals and administra- mental health mally adequate training might required working for or under contract with tors safety to ensure and freedom restraint. in- The individual defendants ADMHMR. 315-17, Id. 457 U.S. at 102 S.Ct. 2458-59. Mazick, Ph.D., Eufaula’s clin- Bradley clude: Discovery completed. The defendants Juris, director; a Eufaula social ical Karen summary judgment qualified all moved for McBride, worker; psy- a licensed Andrew immunity grounds. The district denied Eufaula; Money Man- Medical chologist with Videon, their motions. Dolihite Inc., corporation under agement, private (M.D.Ala.1994). The F.Supp. 918 defen provide psychiat- contract with ADMHMR brought interlocutory dants-appellants Eufaula; this Mau- Drs. Robert ric services Jenkins, jurisdiction.3 Mitchell v. appeal. We have ghon psychiatrists and Chester concluding During litigation, that the court erred Dr. Mau- district the course event, genuine ghon amend- issue of fact as to the offi died. After this there Mary substituting complaint the name of act ed their involvement in the act. The itself was cial’s Videon, Fay of his estate Dr. executrix law. The Court violation of established Maughon's simplicity and insufficiency" name. For the sake of issue was noted that this "evidence Maughon brevity immunity we will refer issue held different from understanding holding applies to our the immediately appealable v. For to in Mitchell defendant, Mary Fay 2806, Videon. 511, now-named syth, 105 S.Ct. 86 L.Ed.2d 472 U.S. (1985). "countervailing consider 411 Several Youngberg civilly Although extending involved a commit- persuaded to the Court decline ations” mentally person, ted retarded this circuit has appealability to include the rule of immediate - Youngberg holding apply interpreted Johnson, to the to insufficiency" issues. "evidence civilly patients. involuntarily, See, mental committed at -, U.S. 115 S.Ct. 696, e.g., Campbell, 49 F.3d 701 Wooten v. County, Georgia, 62 F.3d In v. DeKalb Ratliff Cir.1995) (“In (11th Youngberg..., Court ex- the (11th Cir.1995), court addressed an is- 338 this analysis holding that the sub- tended the Estelle After in Johnson v. Jones. sue similar to that component of Fourteenth Amend- stantive the resolving jurisdiction claim accepting one requires the state ment's Due Process Clause immunily, qualified addressed the the court patients involuntarily provide committed mental immunity qualified with public of officials’ claim necessary to ensure such as are with services gender respect of discrimina- to Ratliff's claim safety’ from themselves and their 'reasonable argument public only officials' 308, tion. others.”); Rodgers Horsley, 311 v. 39 F.3d immunity respect qualified of ("In this claim (11th Cir.1994) Youngberg,the Court creat- support any discriminato- that the record did not principle persons general legal who ed the court, ry part. their Id. 341. This intent on involuntarily mental insti- are committed state conditions, necessary noting discriminatory intent was right to freedom tutions have a safe tort, restraint, underlying de- right of constitutional bodily minimal element the from training.”) the district court's determina- clined review genuine of fact as to was a issue tion that there discriminatory appellants acted with in- whether challenges jurisdiction party our under 3. Neither of fact in Like the nonreviewable issue tent. Supreme opinion, v. the Court Johnson recent Johnson—i.e., appealing public 2151, offi- Jones, - U.S. -, whether the 115 S.Ct. 132 L.Ed.2d allegedly review, actually in the uncon- (1995). cial was involved we conclude 238 After careful appeal beating—the in of fact on appeal. stitutional issue jurisdiction this In we have of John son, predicate element of the by factual argument appeal the also only made on the Ratliff Johnson, underlying like seeking immunity tort. Also public qualified constitutional official 1034 actions were lawful. See Lassiter v. Alabama A & involved an “evidence insufficiency” Univ., Trustees, Ratliff is- M Bd. 1146, 28 F.3d 1150 of also, sue. See Bowers, (11th Mastroianni v. Cir.1994) (en 74 banc). F.3d (11th Cir.1996) ("Insofar 236 Thus, as appeals from the identification of the actions and summary denials judgment of relate to knowledge 'factual public of each part official is disputes' or 'insufficiency parcel regarding evidence' qualified of the core immunity issue which plaintiff's claim, this court appellate juris- lacks is immediately appealable. inquiry This is distin- diction.”); City Babb v. guished Lake Community College, from the factual issues found to be unre- 270, (11th 66 F.3d Cir.1995) ("An 272 viewable in respects. First, order Johnson and in at least two Ratliff determining the existence or non-existence of a in both Ratliff, Johnson and the triable issue of sufficiency appeal fact—the issue on of the predicate evi- involved a element of dence—is not immediately appealable.”). underlying tort; the by contrast, constitutional case, Unlike Johnson and Ratliff, unlike primary issue we address is quali- the core argument of appealing public i.e., each fied immunity official in this whether a reasonable issue— case is public that a public reasonable official could official have could believed that his or her have believed lawful, that his or actions light her were actions lawful in clearly were established light clearly law and established possessed. Second, law and the information infor- possessed mation by both Ratliff, each Johnson and challenge official. appeal Anderson v. Creighton, 635, 641, 483 involved U.S. 3034, sufficiency of 107 S.Ct. evidence to create 3040, genuine fact; (1987). 97 contrast, L.Ed.2d by 523 issue of argument This in this case appealing raises the therefore, each qualified public core immunity is, official issue raises core qualified immediately immunity appealable issue identified above. under Mitchell Forsyth, 511, v. Our 472 2806, U.S. conclusion jurisdiction that we have 105 S.Ct. 86 identify (1985), precise L.Ed.2d 411 actions and precise Johnson. knowledge respect With appellant each supported by several relating subissues Eighth recent several Circuit appellants, Groose, decision order Reecev. to evaluate the (8th 60 qualified Cir.1995). F.3d 487 Reece, core immunity presented issue by each held jurisdiction appellant, that it had we have "to identified examine precisely the facts the rele- they government vant known to the appellant actions of the official in and the relevant order to determine possessed each, clearly-established whether information by course, taking law would be by all violated actions.” Id. at 489 inferences in favor of Dolihite. (noting that required Anderson acceptance We are jurisdiction confident we to do this. jurisdiction). such Romero, Numerous other ap- 518, Anderson courts Cf. F.3d pear to have implicitly Cir.1995) ("[The jurisdic- assumed such issue] is whether in 1992 the See, tion. e.g., Miller, Lennon v. right F.3d constitutional prisoner of a [plaintiff’s] (2d Cir.1995) 422-26 (undertaking position review of ... to be free specific from the acts that facts," “undisputed i.e., record evidence con- alleged defendants are to have committed cerning the plaintiff's facts underlying claim, to established....”). apparent As is police determine whether officers’ actions were from above statement of the core objectively reasonable); Rodriguez v. Phillips, 66 issue, immunity para- statement was (2d Cir.1995) 480-81 (examining cir- phrased Anderson, 483 U.S. at prison cumstances of to determine whether it S.Ct. at it is necessary to examine the was objectively reasonable for the official to be- precise actions of each appellant precise and the plaintiff's lieve administrative confinement did possessed information appellant each in order not violate rights); his constitutional Buonocore to determine whether a public reasonable official Harris, 347, v. (4th 65 Cir.1995) F.3d 357 (noting could have believed that his or her actions were that, to determine whether actions violated clear- lawful, light in of established law. ly law, established the court must the examine respect With to several of the mental health facts alleged by plaintiff); as Nichols, v. Sanderfer professionals case, in the instant to determine 151, 62 (6th F.3d Cir.1995) 154-55 (appellate what law clearly established, is we must under- court itself identified the relevant actions of the take a fact-sensitive controlling examination of public official, nurse, a in order to evaluate law, case particularly Greason Kemp, v. 891 F.2d whether she was deliberately indifferent to a (11th Cir.1990). 829 We compare must then the pretrial needs); detainee’s Ross, medial Prosser v. (which facts in such law case have been deter- 1005, (8th 70 F.3d Cir.1995) 1006 (noting that mined to inbe Constitution) violation of the with the district court failed to indicate what facts it precise the precise actions and the knowledge of believed to be dispute in searching and the rec- the actors in this case. For example, appellant facts, ord undisputed for and noting also that the Dr. Jenkins in the instant case comparable is imposed limitation by Johnson "will sometimes psychiatrist the in actions, Greason. Dr. Jenkins' make it difficult jurisdic- determine whether knowledge time, and his at the must be identified tion exists deciding because whether an officer is precisely compared and then to the actions and qualified entitled to immunity requires a 'fact- knowledge psychiatrist of the in Only Greason. if inquiry”). intensive' We have contrary found no the Jenkins, of actions Dr. light in of his knowl- authority. edge, materially are similar to the actions and Even if we are incorrect in our that conclusion knowledge psychiatrist of the in Greason can it the precise identification of the acts and knowl-

be said that he could not thought have edge that his of each appealing public part official is and

1035 in and law clearly established of the 2806, light 525-28, 105 S.Ct. 511, 472 U.S. Forsyth, by each possessed information of the light (1985). 411 2815-16, 86 L.Ed.2d appellant. background the set out will opinion This address then and law the relevant and facts qualified FACTS defendant each I. BACKGROUND of entitlement the pos- summary judgment In the immunity. County 1991, Baldwin the February of all case, take we this of ture Dolihite David adjudged Court Juvenile plaintiffs the of favor inferences factual pro- of because supervision of need bur- the bear However, the below. school.4 and home behavior blematic appellant, to each respect With proof. of den custody of in the placed court as identified facts relevant the taken have we Department the instructed and ADMHMR same supplemented court district by the parents custody of child the return a reason- whether to evaluate necessary as Eufaula the completed successfully after that believed have could official public able reside, for the continued lawful, program. appellant each of actions the However, with at -, at 2159. 115 S.Ct. U.S. than other case appellants in issue, the respect to immunity we qualified core parcel of the court’s district Juris, conclude we cannot "inextricably inter be it would are satisfied knowledge of actions of identification issue, would and thus core with twined” Supreme adequate. appellant each See jurisdiction. appellate pendent our within a in such acknowledged that in Johnson Comm'n., Court circumstance, U.S. County 514 Chambers v. Swint appropriately appellate court an 1212, 60 L.Ed.2d 131 -, -, S.Ct. 115 Id. identification. such to undertake have juris would pendent issue (also suggesting (1995) (2d Senkowski, 84-85 F.3d 62 v. Rivera pendent of review Cf. where may exist diction dis where (examining evidence Cir.1995) record meaningful review necessary to ensure is issue adequate factual an - to articulate faded Johnson, court trict issue); immunity qualified of the declining hold relied it upon which basis (suggesting that at -, at 2159 S.Ct. 115 U.S. respect to suit). With immune defendants insuf even evidence of jurisdiction issue pendent actions Juris, of her identification our appellant appealing exist). an When may ficiency issues of with knowledge is consistent qualified immu core presents the official public instances, court; we have made in other district ap pendent issue, that we we believe nity Especially in precise. more identification presented issues other of jurisdiction pellate providing professionals care health of context “inextricably are issues other if the official such inqui immunity care, qualified core medical v. Blue See issue. core with intertwined" of sides on both sensitive exceedingly fact ry Cir.1995) is (2d n. 6 Koren, F.3d involving the the coin of the side On the coin. ruling court’s district (finding law, it is clearly established determination with fact remained of material genuine issue acts precisely the identify necessary to is review immunity issue respect to the controlling actor comparable knowledge of the where jurisdiction pendent the court's able under involving the coin of the the side On cases. claim and constitutional it is intertwined official, nec it is public appealing actions of whether meaningful review necessary demonstrated, identify pre essary, we have stan appropriate applied the the district appealing knowledge cisely actions refer Swint’s to address dard). Every circuit Ala v. Lassiter stated As we public official. has issues “inextricably intertwined” ence Trustees, F.3d University, Bd. MA & bama exists. jurisdiction pendent that such concluded banc), plaintiff (en Cir.1994) (11th 1146, 1150 Springs, City Blue See, e.g., Kincade or abstrac propositions general rely upon cannot City Cir.1995); Kaluczky v. 394-95 clearly estab a violation to demonstrate Cir.1995); tions (2d Plains, 206-07 57 F.3d White controlling rather, of the law; the facts lished 57 F.3d Wynnewood, City Moore to those materially similar be precedent must case, identifi if the Cir.1995). even In this Id. case. instant knowledge of and actions precise cation core parcel of part and appellant is each issue, no had David adjudication time 4. At is, above discussion it believe as we drug or alcohol history of or juvenile convictions is "inex issue conclusively demonstrates adjudged been had by he But absolutely abuse. delinquent Indeed, it tricably intertwined.” someone a knife drew he because public offi precisely the identify necessary to was he where Robertsdale Boys Home at the to resolve knowledge in order actions cial’s a result As go Eufaula. waiting while sent immunity issue. core When home. again sent he was this incident given” simply "take as might Ordinarily, we misbehaving at by probation his violated he appel- of each identification court’s the district a De- Program, Hit school, to the sent Johnson,- he knowledge. See actions lant’s part, most with parents his until he was threats gestures. The following inci- admitted to Eufaula January 1992.5 dents occurred while David Eufaula and are documented in By his January 23,1992, Eufaula record had David been eval- unless otherwise indicated. On January 26, uated three of the defendants —Dr. Mau- 1992, a nurse treated ghon, David for psychiatrist, deep punc- Juris, worker, a social ture wound in his left wrist. McBride, told the psychologist.6 It was deter- nurse that he going “was to cut mined his arm through off these evaluations that David and kill himself.” David placed reported had on con- having attempted suicide,7 had tinuous observation, i.e., one-on-one observa- frequent ideations, suicidal was obsessed tion, until the day next Juris, when after with writing poetry death, about and had completing a assessment, suicide moved him family some history of suicide.8 Appellees to close observation with one-hour checks.10 also contend behavior described in that. On the suicide form, assessment Juris noted David’s Baldwin County Mental Health De- family David’s did not knowledge partment evaluation could be construed as past David’s suicide attempts and that psychotic.9 After his initial Eufaula evalua- David’s self-reported past gestures could not tions, David was assessed as giving the “di- agnostic impression of conduct disorder soli- be confirmed. In Progress Notes, David’s Juris indicated that reported his suicidal tary aggressive type.” thoughts were intermittent and gen- without days Ten after arrival, David’s psychia- uine intent. trist Dr. Jenkins and appellants McBride and Progress they not appear be manipulative to more in na- did being admit to frustrated pm 1/26/92 10:30 ture or significant the result of depres- clinical and reported himself having to only a fleeting sion.” At least one suicide threat was thought document- of suicide.” She then moved him from ed in his County Baldwin Mental Health Center continuous observation to close observation sta- Evaluation. David threatened suicide in March tus and indicated he that was to be checked of poem 1991 in gave a he girlfriend. to a former every hour. again.’ them remove “would in” and put David life.” of facts the are Death, Suicide David’s about Dr. Jenkins nurse notified The behavior for his restitution work given was pre- Dr. Jenkins phone, the Over intervention, behavior. therapeutic no additional but and Vistaril, tranquilizer, a mg of medications, scribed and any prescribed he was nor David of restraints. use soft the authorized completed.11 was form assessment suicide no again. room emergency the to taken was him- talking to 18, David was February On continuous, on placed David ordered Juris talking he was that a nurse advised and self constant, i.e., observation. On do.” to what told him who a friend “to completed a suicide day Juris next The David found member 24, a February staff her According to David. on form assessment the beside room his in floor sitting on the intent, psychotic suicidal notes, denied David salt, cutting of made he a star of figure but depression, of feelings symptoms, and with .his wrist of his back the on into sore prob- to due thoughts self-injurious admitted onto drip to allowing blood buckle, and belt act of Although David’s peers. with lems he member the staff told David star. the on out his sutures pulling and cutting himself day that later David devil-worshipper. awas to be determined apparently was March indicat- which a note member staff the wrote never was attempt, David or gesture suicidal devil the talking because not he was that ed by Dr. Maziek or psychiatrists by the seen 2, indicated Juris March On to. not him told How- altered.12 plan his treatment nor was continued he Dr. Jenkins examined David on March 19. Tuesday, On 24, March a.m., at 8:45 Juris His notes in David’s records only state the met with David. Progress Notes indi- following: “This young man has been engag- cate that the two of them discussed pre- ing in self-destructive behavior. Case re- weekend, vious specifically David’s destruc- viewed therapist and nurse. No current tion of property and aggression. Neither in or past evidence of psychosis. alert, MS: the Progress Notes themselves nor else- oriented. Thought orderly. Affect indiffer- where in David’s record is it documented ent. Memory and intellect intact. This diffi- that Juris knew about the weekend hanging culty seems behavioral. T think I up messed attempt.17 At that meeting she told David ” may be a little bit crazy.’ There is no that the treatment team had met previ- further indication in the record of what ous sort morning and had decided to give David of assessment or examinations were complet- days three dorm restriction due to his behav- ed to render this conclusion. David’s ior. treat- plan ment was not altered. Her Progress Notes of March 24 also indi-

On Saturday, March p.m., 9:25 cate that she had left instructions for the staff member ordered placed David dorm staff seclu- to take David off close observation sion after David destroyed facility status on property, morning of March if21 March threatened to cut himself with piece had been uneventful. According to the glass, and stated he going Progress Notes, to hurt him- the dorm staff did not re- self if got the chance.14 ceive that inWhile order. Juris seclu- renewed the order sion, David beat his wall, head p.m. on a effective 1:20 cursed March 24. loudly and was described “totally out of Although David’s records do not reveal control.” The nurse on duty notified Dr. that Juris knew of the attempted hanging, Maughon phone over the about David’s be- the plaintiffs presented evidence that Juris havior. Maughon instructed the nurse did know about the incident. A former Eu- administer 50 ofmg Vistaril. resident, faula Fowler, John signed an affida- Sunday, On March vit stating: around p.m., 9:30 mental health worker restricted David to the I inwas the time-out room on time-out room for destroying facility proper- 1992.... David did try to hang himself. ty.15 According to the time-out records com- Ms. Juris knew this because the day, next pleted by mental health worker Forte, Allen David and I talked with Ms. Juris about it. David attempted to hang himself at 9:35 p.m. Ms. spoke Juris to both of us together At p.m., 9:40 David placed in seclusion. about trying hang himself the According to defendants, Forte did not night before. She knew David had tried inform his supervisor shift incident, of this hang himself and she confronted togeth- us supervisor made no mention of it in er about it and David admitted it in her report.16 shift There is no evidence that presence my and in presence. the hanging incident was mentioned in the report shift or that the clinical staff discussed At p.m. 3:30 on March after David went it at their March 23 morning meeting. off close observation, Dr. Maziek and David 14. The social duty worker on stated in David’s toward staff and attempt pull light down a Progress Notes that David was secluded for fail- fixture out of the ceiling. Denson, Samuel an- ing to directions, follow staff's threatening to do worker, other mental health rather than Allen himself, harm to riot, inciting a racial and caus- Forte filled out the seclusion form. ing disruption to therapeutic environment. 17.Juris did write Progress David's had tom his another and David hit members staff seen Dr. which during discussion18 a short had occasions, he that and numerous on resident David’s of cognizant not Mazick, apparently Juris, Dr. Mazick and Dykes, told personally week- previous the of behavior self-injurious that asserted He also incidents. those about in engaged not he had that end, David told time-out residents put the members staff and days several for behavior self-injurious In reasons. inappropriate for seclusion and needed [David] that not see he “did that Eu- Forte, a former testimony, Allen sworn observation.” close on remain had seen he that testified employee, faula was David p.m., afterwards, 4:10 at Shortly a twelve- and that children strike supervisors closet dormitory room hanging found sexually abused been had resident year-old per- was CPR Emergency shoestring. by a residents. by other twice He was resuscitated. was David and formed Eufaula the introduced also appellees The Birming- Hospital to Children’s sent then that evidence as Advocacy Report FY 91-92 he suf- that determined it was where ham Eufaula, re- That at rampant violence Accord- damage. brain hypoxic severe fered complaints thirty-three that indicated port March, court, of as district to the ing However, report by residents. filed were and condition in serious remained David more of substance indicate not does itself old. three-year aof level at functioned report The complaints.20 of those a few than during that reflects investigations record The on whether instead focuses three Eufaula, received he at days It con- seventy adequate. were incidents of those therapy with of individual staff hours half that one and they were that cluded group worker, hours and six Juris, proper a social to conduct training how on needed period for a secluded therapy. He investigations. for ten restriction hours, dorm fourteen DECISION COURT’S hours. sixty-four DISTRICT for II. time-out days, and twice, by a psychiatrist defen seen only denying court, He district 19. on March again stat judgment, upon summary admission once for motions dants’ psychologist, Ph.D. Mazick, staffs “[i]t Eighth Amendment under that ed 24. briefly possess governments David saw state that settled well mini provide obligation to ‘a constitutional John Kirby and Billy affidavits In the whom to those care medical adequate mally Allen testimony of as the Fowler, well as ” incarceration,’ Doli by punishing they are that evidence presented Forte, 918, 926 F.Supp. Videon, 847 v. hite activity, violence gang there Eufaula Thigpen, v. (citing Harris (M.D.Ala.1994) by the staff. residents, and abuse between Cir.1991)). The 1495, 1504 came that David stated Fowler John to invol subjected persons that noted members, that gang hide once to room “‘entitled are commitment untary civil were gang members Juris told and conditions treatment considerate more allowed David, staff threatening conditions whose criminals than confinement residents. other mistreat members gang ” Id. punish.’ designed are confinement hit staff the Eufaula also claimed He Romeo, 457 U.S. Youngberg (citing residents,19 he had at the cursed a resident investigation revealed affidavit, fourth ex- According to Mazick’s 18. punish- means as a secluded might ment; been ain Mazick speaking with interest pressed an a referral requested resident a fifth occurred encounter seemingly chance injury but was of an treatment nurse office. Juris’ outside the hall inwas while inves- Some following afternoon. until seen attachments included accounts tigation threw member a that once stated also He one, re- resident Report. Advocacy resident, the stairs. down Kirby, another Billy in his himhit worker health ported a mental a staff member mouth; indicated another complaints behind recount report did residents; con- a third cursing been report- had One resident investigations. some reported a resident in which resident; the incident cerned by another ribs being in reported kicked ed resident; by another ribs in the being kicked face being in the hit resident another in which an incident and, described a fourth reported that member; resident a third a staff eye. right on his reported bruise resident up; a him to beat threatened staff member 322, 2452, 2461, plaintiffs, 102 S.Ct. 73 L.Ed.2d 28 would amount to deliberate indif- (1982)). Thus, precluding summary the court concluded that “Ro- judgment ference thus qualified immunity grounds. meo made it clear the Fourteenth requirements process Amendment due im- The district court denied the other defen- posed on state officials who are to entrusted summary judgment. dants’ motions for All care for civilly those who have been commit- appeal the defendants here that court’s deni- considerably ted to state institutions are al summary judgment of their motion for rigorous imposed more than those under the qualified immunity grounds. We first set Eighth applicable Amendment are appropriate qualified immunity forth the prisoners.” F.Supp. at 847 analysis, and then we address the facts and court, elucidating The district law relevant to each appellant’s the law to individual applied, be set forth the rule case. established

Romeo, “liability which held may

imposed only QUALIFIED when the decision pro III. IMMUNITY departure fessional such a substantial from The denial of qualified immunity is accepted professional judgment, practice, or a question of law to be reviewed de novo. person standards as to demonstrate that the (11th City Wadley, Swint v. 51 F.3d 988 responsible actually did not base the decision Cir.1995). appeal Because this is an from judgment.” 323, on such a 457 U.S. at 102 motion, summary judgment the denial of a S.Ct. at 2462. The district court also cited we must light view the facts most Waldrop the Eleventh Circuit cases v. Ev plaintiff favorable below. Id. (11th ans, Cir.1989), 871 F.2d 1030 and Grea analysis immunity re (11th Kemp, Cir.1990), v. 891 son F.2d 829 quires the court to determine whether de proposition for the that it is also well settled clearly fendant violated established constitu charge prison officials of the care Fitzgerald, tional law.21 In v. Harlow 457 put inmates are liable if on notice of suicidal 818, 800, 2727, 2738, U.S. 102 S.Ct. 73 fail to pre tendencies and take reasonable (1982), Supreme L.Ed.2d 396 ex Court prevent cautions to suicide. The court rea plained qualified immunity protects gov soned necessarily that this would apply rule ernment officials performing discretionary emotionally those trained to care for dis liability functions from civil if their conduct youths given turbed the Romeo rule that due “clearly violates no statutory established process rights civilly of the committed exceed rights constitutional of which a reasonable Eighth rights Amendment of the crimi person would have known.” Id. 457 U.S. nally incarcerated. 818, 102 S.Ct. at 2738. Juris, respect With a social worker and primary therapist, Qualified immunity the district court is intended to focused on the give Fowler affidavit which ability indicat- officials the anticipate when ed that Juris knew about 22 may the March at- their give liability conduct rise to for tempted damages. suicide. court also Creighton, concluded Anderson 483 U.S. jury 635, 645, 107 that a 3034, 3042, could find that she did fact S.Ct. 97 L.Ed.2d 523 (1987) portion (‘Where read the of David’s record which qualified immunity] [the rule attempted indicated that he had hang is applicable, can they officials know that will Id. himself. at 931-32. being personally There evi- be held long liable as as their dence that she knew the suicide attempt of light actions are reasonable in of current steps law.”). but prevent failed take plaintiff American A must establish suicide, attempting truisms; the district legal more than broad he or she precedent court determined that our under must demonstrate that the law fixed the Greason dictated a conclusion right that her ac- contours of the so that a reason tions, light taken most favorable to the able official would have understood his acts step analysis Cir.1992). 21. The first is to determine 1539 That the defen- acting acting whether officials were within their discretionary dants were within their au- discretionary authority. Taylor, thority Sammons v. is uncontested here. training 639-640, adequate or reasonable to further 107 S.Ct. Id. at unlawful. dictate, safety and freedom from re- ends of Thus, must “pre-existing law (not 102 S.Ct. just suggest or straint. 457 U.S. is, compel truly (1982). addition, Romeo es- about), L.Ed.2d the conclu- question or raise a allow involuntarily civilly like-situated, com- gov- tablished every sion higher of care doing is mitted were due a standard defendant agent that what ernment committed; criminally persons sub- circumstances.” than the law in the federal violates University, jected Bd. are involuntary A M to civil commitment Alabama & Lassiter v. (11th Trustees, 1146, 1150 Cir. more considerate treatment 28 “entitled of 1994) (en banc) original). (emphasis in the than criminals conditions confinement “ Moreover, need not 'be creative confinement are de- officials whose conditions of drawing analogies previ- 322, from imaginative punish.” in signed to Id. U.S. at 102 457 ” (citations at ously Thus, Id. 1150 decided cases.’ it from at 2461. follows Romeo S.Ct. omitted). same, that, being other circumstances all professional mental actions of a health Anderson, Supreme de- Court In Eighth prisoner’s violate a Amend- would immunity analysis: qualified scribed pro- rights ment would also violate due right must be suffi- of the The contours involuntarily civilly commit- rights cess of the official ciently clear prisoner’s Eighth An officialviolates a ted.22 doing is that what he would understand rights is when the official delib- Amendment say is right. This not to violates that prisoner’s serious erately indifferent to the protected by qualified an official action Gamble, 429 medical needs. Estelle U.S. very ques- in immunity action unless (1976). 50 L.Ed.2d S.Ct. ... held unlawful previously tion has been pre- say light in the but it is invol- Although Romeo that the establishes ap- must existing law the unlawfulness civilly due untarily committed have certain parent. rights at process rights and that those are (citations 107 S.Ct. at 3039 483 U.S. rights of the crimi- as extensive as least omitted). institutionalized, legal that broad nally clearly is insufficient to establish truism applied objective have an Our courts overcoming appel- purposes of law for qualified immunity test reasonableness immunity in this ease.23 qualified claims lants’ circumstance, taking the facts In each cases. determining appellants in whether the defendant, particular “the rele known immunity, qualified we are entitled case summary judg question on a motion vant forth the at ease law which sets must look immuni ment on a defense based recognized rights process of the due contours ty is official could have whether a reasonable Romeo, Because, the due in Romeo. under his or her actions were lawful believed equiva- were at least process rights at stake clearly the infor light law and established Eighth comparable Amendment lent by the time possessed the official at mation committed, criminally rights relevant Stewart v. Baldwin the conduct occurred.” Eighth Amendment context case law the Educ., County 908 F.2d Bd. of the contours of the to set forth also serves Cir.1990). civilly committed. process rights of the due matter, general As under Ro to each facts relevant civilly We will address the involuntarily committed have meo the light appellant in of the relevant process individual liberty the due clause interests under determine whether safety, case law. We must Amendment of the Fourteenth that a restraint, the conclusion minimally law established bodily freedom from Moreover, Romeo, Supreme Court did public require holding offi- 22. This does “ imaginative drawing would creative or facts of that case cials decide whether the analogies previously decided cases'" pro- plaintiff’s due a violation of the amount to Lassiter, 28 F.3d at to Lassiter. contravention Rather, rights. Supreme remand- Court cess plain is set forth in the 1150. The conclusion decide. for the lower courts to ed the case analogies. requires language no of Romeo reasonable official appel- at the time of the health needs in Eighth violation of the actions, knowing lant’s appellant Brown, what Amendment. Calvin the mental knew, would realized that those charge acts health team leader of the inmate’s (Greason’s) rights. violated David’s constitutional care and one the defendants in case, summary judgment was denied qualified immunity grounds. Brown knew IV. THE APPELLANTS facility that while at the Greason had been A. Karen Juris experiencing feelings despair thoughts primary therapist, of suicide As David’s one occasion attempted Eufaula so- cial kill frequent tying something worker Juris had the most himself con- around his during tact with throat. reported This incident had time Eufaula. been suicide, history She conducted a social Brown well before on him Greason’s when final admitted; inmates, only by reported by he was two she knew he hav- but also Grea- ing attempted parents threatened and son’s on facility or suicide who a visit to the be- arrival; his help fore she was his asked Brown for his respect treatment team; assigned problem. she was Nevertheless, him Id. at 832 n. counsel week- & 8. ly notify for half hour Brown psychiatrist one and to act did not co-therapist as the staff or during weekly put group session;24 his Greason on therapy suicide watch. The court self-injurious she knew David’s concluded or such conduct suicidal violated the dece- Eufaula; Eighth behavior while at dent’s rights: she conducted Amendment two written suicide in assessments the rec- question here is a narrow one: wheth- ord; she contacted Dr. Jenkins when it was er Brown’s failure to monitor af- Greason recommended that David be evaluated for having ter been par- warned Greason’s medication; and, anti-psychotic she main- ents and two inmates that Greason had tained David on close observation status for tried to commit suicide constituted deliber- much of his time at Eufaula because of the ate indifference. various incidents in which David threatened prison personnel Where directly respon- to commit ges- suicide or exhibited suicidal sible for knowledge inmate care have significantly, tures. purposes, Most for our an attempted, inmate has or even threat- plaintiffs produced evidence from ened, suicide, steps their failure to take which fact finder could conclude that Juris prevent that inmate committing sui- attempted knew that hang David himself cide can amount to deliberate indifference. on March 2225but that she nevertheless took (footnotes omitted). Id. at 835-36 him off close observation status without affirmed the district court’s taking any denial of protect Brown’s other measures to summary judgment motion for safety or otherwise meet his mental health immunity grounds, concluding care “that a rea- needs. person sonable in position Brown’s would indicated, As the district court our prece provision have known that his of care consti- Greason, dent 891 F.2d 829 Cir. tuted deliberate indifference Greason’s 1990), Greason, is relevant. an inmate ” eighth rights.... amendment Id. at 836. committed Georgia suicide while in the Diag nostic (“GDCC”), and Classification Center The situation in this compa case is Georgia Department of Corrections facility rable to that of Brown Greason. Juris where the decedent was being held. The admits that she history knew of David’s family brought decedent’s action, §a illness, i.e., mental his suicide threats and alleging that professionals the mental health attempts gestures or self-injurious and his and administrators at facility were delib jury behavior. If a found that she knew of erately indifferent to the self-injurious decedent’s mental behavior over the weekend 24. The therapy record indicates that David's respect did knowledge also with to Juris' there- prescribed. not occur as often summary posture judgment of. In the of this case, we take the reasonable factual inferences dispute 25. There is a factual as to whether or not plaintiffs. favor attempted hang himself on March light of that information constitut- attempted himself in especially the March beginning violation. to take ed a constitutional Juris’ decision March hanging on on March observation off close comparable to Brown’s presents a situation did not The fact that McBride know Like Brown Grea- in Greason. behavior hanging attempt his situation about the sets any psychia- son, notify failed Juris apart McBride indicated from Juris’. her and available to psychologists or trists community during Monday morning meet mea- protective continue the even to report failed ings, the residential staff would Rather place for David. already sures importance happened clinical what of seeking professional protecting David allege than weekend. The over the actually put alleged guidance, McBride, behavior Juris’ report. McBride saw the seclusion Thus, her of suicide. greater risk David at however, March 23 testified that he read the to the decision which comparable only decision “informed” of a Progress Note but was indifference to constitute deliberate was held Progress re report. The in clearly Grea- established such facts was substantially the same as is This information son, plaintiffs-appellees conclude that we have available had he that which would been support sufficient evidence have adduced 22 21 March seclusion read the March would constitute findings of fact which Thus, no evidence McBride reports. there is clearly con- by established Juris violation attempt, apprised hanging of the but he Thus, dis- we affirm the rights. stitutional self-injurious ten on notice that David’s summary judgment court’s denial trict through weekend. persisted dencies the respect to Juris. with inquire further and McBride’s failure inspection closer out the record for seek B. Andrew McBride light of the fact that should be considered Eufaula, duty on McBride, clinical not on weekends psychologist staff regularly the residential apparently relied on initial one of David’s evaluations conducted occurring report important incidents staff to team. His on David’s treatment and was the residential on weekends and that neither appears to have primary David contact with portion the record McBride group staff nor the David’s thera- as co-facilitator of been to do that David’s threats reviewed indicated knew about David’s py sessions. McBride hanging attempt. oc- himself involved many harm to history and of the incidents Also, assert appellees do not was at Eufaula. The curred while David part in the knew about or took be McBride that McBride should plaintiffs contend David off close observation.27 to take after decision he failed take action liable because hanging 22 However, knowledge of the March attempt. the Without hanging apparent no role attempt knew argue that McBride plaintiffs do observation, off close attempt.26 to take David hanging decision about David’s March failure to take McBride’s we cannot conclude Rather, they argue apprise failure 21-22 of March after the weekend to take action action information and himself of that violation of established doing injury further constituted David from prevent knowledge. clear, Nor is expressly such disavows opinion but it is not 26. The district court’s McBride knew. evidence that there other thought of the may that McBride knew attempt. F.Supp. hanging at 933 part putting David that he did take 27. The fact ("McBride perform a suicide assessment did not indicate that he restriction does not on dorm time, despite his awareness of at that on David off of part to take David decision took close observation status. report, depo. 28- McBride Mr. Forte’s There no indication However, 32_”). our careful review plaintiffs do presented evidence in the suggestion deposition allege that McBride a resident no meant that reveals that dorm restriction indeed, automatically observation. taken off close attempt; hanging McBride knew of constitutional law or personnel under Greason28 other tendent failed to seek needed Eighth Instead, relevant Amendment Fourteenth on his own initiative. he relied case law. funding the medical administrator to seek personnel for the through regular bud Although plaintiffs presented evi- getary process. expert dence an affidavit from an which stat- ed that Andrew McBride “failed to meet The case at bar is different from Howell. professional basic standards the evalua- Howell, facility medical staff indicated tion, assessment, David, and treatment” of superintendent “prisoner any specificity the affidavit does not with could not be treated under the then current indicate how McBride’s evaluation and treat- facility. conditions” of the In the case before profes- ment of failed to meet basic us, the record that the indicates Eufaula staff conclusory sional A standards. affidavit of could plain- have treated David. Even the support provides this nature little for the experts tiffs’ do not contend that Eufaula appellees’ claim. Rather, not equipped David. treat expert simply point affidavits allege

The Dolohites also to deficien- that McBride professional cies should liable actions Eufaula’s because failed to recom personnel.29 mend that David be transferred to another facility though even he considered ac conclude We the facts adduced tively poli suicidal and knew Eufaula’s appellees fail show defendant admitting actively cies did not authorize sui clearly-established McBride violated consti- patients. cidal Eufaula See Adolescent tutional law. Policy 3.47, Criteria, Center No. Admission However, # 2.E. no gov cases hold that a Money Management, C. Medical facility ernment official’s violation of or de Jenkins, Chester and Dr. Robert Mau- partment more, policy, without constitutes a ghon See, e.g., constitutional violation. Edwards Money Management 1. The Medical Gilbert, 1271, (11th v. 867 F.2d 1276-77 Cir. Contract 1989), denied, modified, reh’g Edwards v. (11th County, Okaloosa Maughon F.3d 358 Cir. Drs. Jenkins and were 1994). who, psychiatrists Our case law does indicate that employees fail as of Medical ing Inc., to or Money transfer accommodate the Management, serious were under con health prisoner needs of a could amount to tract with provide psychiatric Eufaula to: a basis, constitutional violation. In Howell v. Ev services consulting on a admit resi ans, (11th 712, Cir.1991), dents, 922 F.2d 722-23 plans, write initial treatment deter moot, vacated as 931 F.2d 711 patients’ Cir. admitting diagnoses, prescribe mine 1991), medications, by unpublished reinstated perform reviews, order as medication ex noted, (11th Cir.1994), 12 F.3d 190 this amine discharge, provide residents before ex court superintendent that a pert testimony court, concluded of a provide twenty- and facility correctional qual was not to coverage. entitled four hour physicians call As under immunity following ified state, under the facts. contract with psychiatrists the the superintendent The knew that an subject liability inmate were state actors under urgent an particular Atkins, § had need for type a of 42, v. See West 487 U.S. 55- personnel. 58, medical 2250, 2259-60, After the denial the 108 S.Ct. 101 L.Ed.2d 40 superintendent’s (1988); Services, recommendation that the Ancata v. Prison Health released, medically Inc., (11th Cir.1985). inmate be superin 769 F.2d Be- Brown, 28. The actions of Calvin the mental being observation status and ev- monitored Greason, ery health team leader in can be fifteen minutes. distin- guished from McBride's actions here. Brown protect took no measures to instance, Greason or to seek Halpem, 29. For Dr. Abraham appropriate help for Greason. The evidence in plaintiffs’ psychiatric expert, concludes that that, the record indicates as far as McBride psychiatric David should have received medi- knew, being protect measures were taken to options cation therapy. and more intensive Both himself, i.e., David from apparently David was on close were available at Eufaula. autho- Dr. Jenkins phone Over liability wound. subject individuals they are cause and Vistaril, tranquilizer, a use rized enti- are also psychiatrists § under did necessary. Dr. Jenkins restraints, if defense soft as a immunity raise tled the incident. up on not follow liability. psy- that concluded district The stuck a David after Then treatment David’s chiatrists, members Eufaula of March wound pencil implicitly authority and team, had broad David. about Dr. Jenkins contacted again al- notwithstanding their responsibility broad room emergency Nixon, the day Dr. That Medical under duties limited legedly on March David treated also had who doctor Dolihite contract. Management Money medical in David’s emphatically 8, indicated However, only F.Supp. at 930. Videon, 847 ex- psychiatric needed David that records team, treatment David’s onwas Jenkins Dr. 19, was day, March next The amination.31 David’s onwas Jenkins Dr. that fact and Dr. that only time day and first itself, not, and does team treatment reviewed or David saw either Jenkins responsibilities broader had that indicate Jenkins, he Dr. According to record. David’s Sig- the contract. under set forth those than He David. with hour half one about spent evi- adduced appellees nificantly, examination.” status “mental conducted duty to had psychiatrists that dence examination, as March duties. these Dr. Jenkins’ scope of fulfill Although the well- not was examination” status “mental 19 Jenkins Dr. Chester 2. apparent it is plaintiffs, by the developed he formed that deposition Jenkins’ Dr. from Dr. Jenkins Relevant Facts a. no evidence was there opinion that assigned psychiatrist Jenkins was Dr. delusions, psychotic or depression, clinical did he Although team. treatment David’s that opinion Dr. Jenkins’ It was behavior. ren- or initial evaluation David’s conduct self-de- exhibiting “non-suicidal was David signed Dr. Jenkins diagnosis, initial der was i.e., that behavior,” behavior structive January, 1992. late plan in treatment David’s behavior life-threatening and but harmful ges- and ideations suicidal listed plan The The explanation. some was there which for and problems primary among David’s tures im- was such behavior that was explanation “con- diagnosis Maughon’s Dr. recorded things about related and pulsive type.” aggressive solitary disorder duct i.e., David angry frustrated — was David Jenkins Dr. notice came next manipulative ain using behavior such member Eufaula when on opinion ultimate Jenkins’ Dr. fashion. pur- had that phone by him notified psychotropic for a need was not there that “want[ed] he arm, stated his cut posely behav- problem David’s drugs and purposefully suicide,” then and to commit ioral. the self-inflicted from stitches removed Psychia- by evaluated “MUST wrote: She pre- 31. Maughon and Jenkins Although both Drs. David, medication....” antipsychotic for trist Vistaril, tranquilizer, scribed prescription that that contend do not plaintiffs follow-up. duty to triggered the 1046 Allegations Against Expert Testimony

b. Dr. Against Jenkins c. Dr. Jenkins plaintiffs presented expert The med plaintiffs allege The do not that Dr. Jen- testimony. ical Our circuit has indicated that part kins took in the decision to take David testimony experts of medical can aid the off close on March 24 or observation determining whether im any Jenkins contacts with David between munity appropriate allegations where the March 19 evaluation and David’s March hinge upon appropriateness of the actions 24 attempt. plaintiffs allege suicide The do professionals, including medical mental that Dr. recognize Jenkins failed to David’s professionals. Evans, health See Howell v. signs depression obvious bipo- clinical and (11th Cir.1991), 922 F.2d 722-23 vacated diagnose lar accordingly. disorder him moot, (11th Cir.1991), as 711 931 F.2d rein They history contend of suicide noted, by unpublished stated order as suicide, family history threats and (11th Cir.1994); Kemp, Greason v. increasing episodes of self-mutilation and (11th Cir.1990); Waldrop F.2d 829 swings diagno- mood led should have to that Evans, (11th Cir.1989); 871 F.2d Rog They sis. assert that Dr. Jenkins should Evans, Cir.1986). ers v. 792 F.2d 1052 prescribed lengthy intense and one-on- expert testimony, Such making medical ref therapy antidepressant one medication specific erence to deficiencies in a defen for David and that the failure to do so was a specific treatment medically dant’s ac departure professional total from judgment. cepted might, conjunction standards plaintiffs contend that Dr. Jenkins had case, specific persuade facts aof a court duty diagnosis make such a rec- the medical defendant’s actions in the ommend such treatment when he was con- great case departure from again sulted March 8 and then when he appropriate previous medical standards as They consulted March 19. as- also departures found prior unconstitutional sert pro- that Dr. Jenkins failed to exercise cases—i.e., might persuade a court that a judgment fessional when he did not see professional in defendant’s shoes They David on March argue that on challenged would have known that his actions David, March when he did see failed (or inaction) violated constitutional in-depth do an in-depth evaluation an or even rights.33 They review of argue the record.32 an plaintiffs presented the affidavit of Dr. in-depth review of the record would have Halpern, Abraham L. practic- certified and revealed evidence of David’s serious mental ing psychiatrist. His affidavit states that the illness illustrated epi- David’s March 15 psychiatrists’ treatment of David was “a total bleeding sode of defecating on the walls departure professional judgment, prac- of the time-out unspec- room as well as other tice or standards such that it cannot be said ified indicating instances ill- serious mental that their treatment of David on was based plaintiffs ness. The also cite Dr. Jenkins’ accepted professional However, judgment.” cursory on any recognize suggestion doctor would light favorable to the the facts in the most calling for intrusive incidents as more these plaintiffs, Dr. would have known of: Jenkins analysis, Dr. Hal- In the last intervention. previous suicidal threats 1. David’s eonclusory and as such is pern’s affidavit gestures; relatively interpretation of little value in our suicide; Thus, grandmother’s we are 2. David’s the facts of this ease. essen- Rather, Halpem’s affida- required Maughon 35. error in Dr. There is another the contract Drs. 34. part of the March 19 evaluation, vit—as of his consideration the initial and Jenkins conduct events, psychiatrist Halpem assumes Dr. medication, up patients prescribe to follow emergency room doctor. have called the should medication, receiving be available for consul- for this claim in his no substantiation There is tation, an as-needed basis. and to consult on case law. affidavit or in relevant 3. Maughon’s Dr. diagnosis initial confirm that he attempted had suicide before David, disorder, “conduct solitary aggressive coming to Eufaula. The record also indi- type”; cates questioned that Juris whether David experienced genuine intent,36 suicidal 4. 26, David’s January 1992, deep possi- that whenever he explicitly asked about bly puncture self-inflicted wound to his left it consistently David denied having suicidal wrist and his statement that he was going to intent, specific a plan, suicidal or being de- “cut his arm off himself’; and kill pressed. 5. February 2, The 1992, incident when wrote, “Oh, David die, God I want to please Having set forth the extent of Dr. take me or I’ll suicide, Death, commit Suicide Jenkins’ knowledge of David at the time of are the facts of life.” on the security screen the challenged treatment, we now turn to in his dormitory room; prior circuit’s cases determine wheth er or not departure in this case is 6. as February 4, The 1992, self-inflicted in- egregious cases, as those jury more so. It is to the left wrist and the Progress Note clear that Dr. departure Jenkins’ in this ease same day indicating that David had is not egregious as departure a as that been presenting irrational; as psychiatrist in Greason v. Kemp, 891 F.2d 7. The February 18, 1992, incident when (11th Cir.1990). case, In that psychi David talking to himself telling atrist —without conducting a mental status staff nurse that he was talking “to a friend exam and without reading an inmate’s rec who told him do”; what to ord—discontinued the antidepres inmate’s 8. 24, The February 1992, incident sant when medication. Before entering prison, the performed some allegedly Satanic ritu- inmate in Greason had diagnosed been as room, inal his inflicted injury further schizophrenic to left with suicidal tendencies and wrist, after which he told a mental health been treated at county mental health worker that the devil told him not to speak; center with anti-depressant medication be cause he had contemplated suicide. Both the 9. 8, The 1992, March incident when inmate’s therapist former at the county facili David cut his arm with piece of metal in an ty as psychiatrist well as a from the Georgia apparently gesture, suicidal and after which Department of Human Resources sent let pulled out the stitches and refused new ters or reports recommending that the in stitches; mate be maintained on his anti-depressant March incident when medication. Both of these letters David bled on the walls and defecated on the inmate’s file. The psychiatrist in Greason floor of the room; time out discontinued the medication without instruct ing incident inmate be when monitored for the re-injured adverse left wrist effects of sticking discontinuing the medi pencil in it again and was cation. sent to the emer- gency room. Similarly, the instant facts are not egre- as In addition facts, to these gious Jenkins those presented in Rogers Evans, would have known that Dr. Maughon had not Cir.1986).37 F.2d 1052 There the psychosis, identified that David’s suicidal concluded deliberate indifference threats gesture problem were supposed- to medical might needs be established under ly being during addressed weekly therapy i.e., a jury circumstances — sessions, and that David’s family could could find that in response justified instance, 36. For point at one she considered his attempts and that David’s self-reported past ges- threats to be for “shock value” and at another tures could not be confirmed. questioned she pervasiveness "the actual of his thoughts and whether or appear not they to be 37. case This did not address the immu- manipulative more in nature.” In the first sui- nity Nevertheless, issue. it binding sets forth assessment, cide Juris noted that family David’s precedent and as such serves to elucidate the did not have knowledge past of David’s suicide contours of the law this area.

1049 say care, fair It is medical inappropriate past of criticism injury in this final David’s preceding actions medi- simply withdrawn had psychiatrist the Waldrop; to those comparable not case are court The 1061. at Id. altogether. cal care clearly is eye left out his gouging Waldrop’s the defendant- that fact the considered also serious most the incident than serious a more psy- inmate’s the treated had psychiatrist to the March prior this case incident fact the and placebos with symptoms chotic 8 self- namely, March the attempt, hanging Prolixin, a treat- used had doctor the that different Waldrop is also wound. inflicted incompe- grossly arguably was which ment pled not had Waldrop in that this case from tent. as diagnosed ill, been had mentally guilty but Evans, lithium, Waldrop v. ease, an on placed A third and depressive, manic and Cir.1989), Greason preceded coming under before drug, all antidepressant psy facility same and that satisfied are same We involved care. the defendant’s guilty pled an inmate re- inadequate case In that defendant-psychiatrist’s chiatrist. at Id. robbery. Waldrop are not armed mentally ill to symptoms to the sponse but the Geor at in this arrived inmate actions Jenkins’ to Dr. comparable When 1032. Center, a Classification Diagnostic and gia case. facility, Corrections of Department Georgia facts that conclude summary, we diagnosed 1984, been he had in October that Dr. show fail by plaintiffs adduced lithium. taking was and depressive manic departure such were actions38 Jenkins’ 1984, evaluated 18, was he October On Id. that judgment professional from concluded who psychiatrist defendant by the known have would in his shoes professional in remis problems psychiatric his that constitution- violated actions that his A 1034. Id. drugs. at withdrew and sion expert’s testi- medical Plaintiffs’ rights. al inter another recommended physician alleged degree of establish mony fails to suffering from Waldrop was because view facts adduced not Plaintiffs departure. psy and nausea. insomnia, nightmares, alleged de- Jenkins’ Dr. to demonstrate 1984, 27, again on October him saw chiatrist judgment professional from parture On medication. on him place not did but to con- found previously to that comparable his fore Waldrop slashed 1,1984, November rights. constitutional a violation stitute not noti psychiatrist arm, although the 1032, On 1034. at time. Id. at the fied Maughon Dr. 3. his left Waldrop gouged 1984, 4, November contentions address next We hospital. Id. taken eye out psy- other Maughon, the Dr. respect with on hospital return his Upon Dr. Eufaula. with contract under chiatrist examined 1984, psychiatrist November limit- David was involvement Maughon’s but drugs two on him placed Waldrop and January of him initial evaluation to his ed he drug antidepressant lithium, the prescription his at 1034. Id. prescribed. been previously had Evaluating Dr. telephone. over Vistaril emergency no ordered also psychiatrist facts then light of actions Maughon’s Later, at Id. Waldrop. protect measures less he had him, clear it known scrotum, his cut facility, the inmate another his Jenkins, and that Dr. than information severely dam testicles, so losing both Dr. than those suspect less are actions it. sight in his lost right eye aged Jenkins. expert medical Pursuant at 1032. Id. evaluation, plain- the initial respect jury With evidence, held opinion geste signs psychiatric that these were “obvious clini- conditions and that those outside depression bipolar cal disorder.” Based professionals had the in- recommended that foregoing, Halpern on the Dr. concludes that previously prescribed psy- on mates remain Maughon attempt properly Dr. “made no only previous chiatric medications. Here the evaluate and treat David for these obvious diagnosis Maughon available to Dr. cursory mental disorders.” This conclusion psychological evaluation from Baldwin Coun- First, appellees not does aid the here. Dr. Center, ty Mental Health and it did set not Halpern’s conclusion that David should have any diagnosis only forth but recommended depressed clinically been evaluated as outpatient that David counseling return to upon bipolar being disorder admitted Eu- placed in program and be a residential if his by supported only is faula the fact that David condition deteriorated. evidence indi- prior attempts had made suicide and threats January cates when the family and that a had member committed done, initial intake was no other doctor or Halpern’s suicide. Dr. affidavit does not set psychologist suggested had that David be any support conclusory forth for his state- anti-psychotic evaluated for medication.41 ment that these factors would have led to the Maughon’s appear Nor does Dr. behavior diagnosis he contends is the correct one. egregious physician be more than that of the Although Halpern Dr. that Dr. states Mau- Evans, Rogers ghon attempt properly “no made evaluate Cir.1986), potentially where the doctor was David,” and treat not does describe what having liable for withdrawn medical care in sort of evaluation should have been conduct- response justified criticisms of the ed. Nor Halpern does Dr. indicate whether family inmate’s her where use of two prescribed or how the treatment should have different ques- medications was called into upon been different David’s admittance had tion. Second, correctly diagnosed. he been there Halpern are no that Dr. indications took into completed After the initial assessment on account when David’s threats were made.39 January Maughon only Dr. was contacted Nor Halpern did Dr. note whether such re- more, Saturday, once on March 21. At that ports of attempts might and threats time, placed David had been in seclusion been, injury inju- absent evidence of or near property destroying threatening after ry, manipulative attention-getting behav- piece glass. cut himself awith He was part ior on David’s as both Juris’ and Dr. beating his cursing head on the wall and Jenkins’ notes in David’s record seem loudly. Maughon Dr. by was notified tele- imply.40 Finally, Halpern’s Dr. affidavit phone, prescribed tranquilizer over makes no degree effort evaluate the telephone. evaluating Maughon’s Dr. ac- Maughon departed which Dr. allegedly had following tions under the circumstances the accepted medical standards. factors are relevant. There is no evidence Maughon’s alleged misdiagnosis Maughon that Dr. reviewed David’s record egregious telephone when psychiatrist less than that of the he was called Saturday, Thus, Waldrop. psychiatrist Greason and 21. That we cannot as- professionals knew that mental health out sume that he had the more extensive knowl- prison system side the previously diag edge Moreover, had which Dr. Jenkins had. nosed the as suffering inmates from serious incident on March 21 about which Dr. Mau- history simply actually attempted The social conducted Juris ever suicide. She noted 27, 1992, thoughts January stated that David had had suicidal suicide assessment form gestures years being family within the two knowledge before admit- that David's no of David's County report past attempts ted to Eufaula. His Baldwin self-reported ges- con- and that David’s August ducted in 1991 did indicate that at least tures could confirmed. In the same re- port one threat occurred in thoughts March 1991. she described his suicidal as with- genuine out intent. example, For Juris wrote on March Nixon, enjoy David continued to psychiatrist, "shock value” of 41.Dr. referred David talking about suicide. The record seems to indi- for evaluation almost two months after Dr. Mau- questioned ghon’s cate that Juris whether David had initial evaluation of David. judgment in his clearly not sional treatment David. as serious ghon was consulted They apparently allegation base this which Dr. Jenkins his about as the one Finally, Maughon, alleged general super- Dr. like Dr. as matter failure to consulted.42 to Jenkins, rely necessary on the Eufaula could vise and to ensure for David the treatment, progress. monitor David’s psychiatric and essential and his failure to see David until two months after plaintiffs readily conclude We recognized having David was assessed and Maughon’s actions to that Dr. failed show gestures. made suicidal threats and professional departure from such judgment professional that a only Dr. personal Mazick had two his actions have known that his shoes would shortly contacts David. The first rights. In- constitutional violated David’s injured his Dr. Maz after David left wrist. deed, Maughon’s Dr. is a against the case ick him after that incident secluded sometime against compelling than the case less fortiori point. him his arm at that and asked about Maughon charged Dr. Dr. Jenkins because briefly Then Dr. Mazick saw David on March particu- knowledge and because the with less had triggered his consultation when he an informal conversation incident which lar triggered than that which with him.43 Plaintiffs have failed adduce was less serious evaluation. Dr. knew that Dr. Jenkins’ evidence that Mazick attempted hang had himself on March 22. Mazick, Bradley PhD. D. The that he had not record indicates seen entry March 22 nor did he know that David Mazick, psychologist, was clinical Dr. attempted injure had himself on March time during David’s of Eufaula director plaintiffs presented evi 21.44 The no further allege Mazick appellees that Dr. there. dence fact finder could infer judgment professional both failed to exercise hang Dr. Mazick knew of the March 22 involved with David’s care psychologist as a ing attempt. Although expert affidavit facility by clinical director and as record, that Dr. Mazick’s behavior was not failing asserts failing to review David’s Juris, professional judgment based on because he failing to Eufaula’s supervise reform record, it is not policies, failing out failed to review the clear seclusion and time alleged abuse the record in prevent measures to Dr. Mazick’s failure review take whether Eufaula. will first address rises to level of uneonstitu- We this situation personal First, treatment of David Dr. Mazick’s not tionality. the record does indicate rights and violated David’s constitutional in the that Dr. Mazick was involved decision alleged Dr. Maziek’s then address whether off close observation.45 Sec to take David discharge administrative/super- failure to ond, plaintiffs have adduced evidence visory to constitutional vio- duties amounted delegate suggest that Dr. Mazick could lations. McBride to responsibility to Juris and bring records and to rele review residents’ of David

1. Dr. Mazick’s Treatment Finally, his attention. vant information to plaintiffs’ expert, upon which the affidavit appellees contended that Dr. generally rely to deficient profes- apparently show plaintiffs departed Mazick from the most basic record, ever, at David’s he would had he looked incident in David's rec- 42. The notes about this self-injurious only Maughon was notified were two ord indicate that “Dr. have realized that there beating banging Apparently, resident head he was about this the weekend. incidents over totally cursing out control—He walls inferring case from David’s that such mg give stat....” said Vistaril 50 Juris’ decision take comments and from off observation. close deposition, he Mazick testified that request- hallway and that David saw David in the he told after the fact that 45.He did indicate speak with him. ed to not be saw no reason David should David that he observation, does but the record off close taken David was due to be off 44. Mazick noted that do contend that he nor not show been free observation status because close days. part in that decision. self-injurious took for several How- behavior wholly professional supervision, conclusory regular given is fact basis that he “had and is of little assistance. knowledge of David’s suicidal condition” and to monitor amount of treatment David readily plaintiffs We conclude that getting. expert The of Dr. affidavit professional to a failed show that reasonable Hamilton asserts that Dr. Mazick “should in Dr. Maziek’s shoes would have known that on have” reviewed David’s clinical course a his actions violated David’s constitutional regular basis and monitored Juris. Howev- rights. er, expert’s provides support affidavit no opinion. supervisory conclusory 2. Dr. for his Mazick’s duties Neither the ex- pert’s any affidavit nor other evidence ad- plaintiffs allege that Dr. by plaintiffs supports assumption duced their discharge supervisory Mazick’s failure to his improper rely that it was for Dr. Mazick to clearly duties violated constitu established bring Juris relevant matters to his relationship tional law and bore a causal attention. injury. It is true that in some situa tions, supervisors may be held liable fail Significantly, Dr. Hamilton does not ad- ing supervise to train and their subordinates degree dress issue to which Dr. adequately. allegedly departed Mazick’s actions from ac-

[Supervisory] liability standards, under section 1983 professional cepted and thus does “must on something be based more than a help plaintiffs discharge heavy their bur- theory respondeat superior. Superviso- of regard. den in sug- Dr. Hamilton did ry liability supervi- occurs when the gest either only psychiatrists that in Alabama personally participates alleged in sor psychologists diagnose could mental illness. However, constitutional violation when there is a expert neither nor their causal connection between actions of the why, psychiatrist’s diagnosis indicate after supervising alleged made, official and the consti- rely upon Dr. Mazick could not deprivation. tutional The causal connec- bring Juris relevant matters to his atten- history can be tion established when of tion. widespread puts responsible abuse su- of None our case law that a su- indicates pervisor on notice of the need to correct pervisor’s failure to monitor an individual alleged deprivation, and he fails do patient’s progress amounts to in- deliberate so.” difference or professional failure exercise Dep’t. v. Cross Alabama Mental Health & of Thus, judgment. if Dr. even Mazick’s ac- (11th Retardation, 1490, 1508

Mental 49 F.3d departed in degree tions some accepted from Cir.1995) Crawford, v. (quoting Brown 906 standards, plaintiffs carry have failed to their Cir.1990)); accord Dean establishing egregious burden such an de- Barber, (11th Cir.1992) 1210, 1215 951 F.2d parture that a professional reasonable in Dr. (“[A] supervisor may be held liable under Mazick’s shoes would have known that he if supervisor personal section rights. violated David’s constitutional deprivation involvement the constitutional Maziek’s actions egregious are as the or if a sufficient causal connection exists Duncan, of Drs. actions Oliver and the medi- supervisor’s between the conduct cal administrators who were denied violation.”). supervisor constitutional A sued immunity in Greason. Both doctors were capacity individual is to qualified entitled inadequacies aware the severe the insti- immunity supervisor unless tution, including inadequate num- would have known that his or her actions professional ber of Both staff. knew that the light clearly-established unlawful particular psychiatrist assigned to the inmate Greason, possessed. law and the information had an excessive burden. Both were aware 891 F.2d at 836-37. psychiatrist that the had discontinued Grea- plaintiffs allege that Dr. Mazick son’s medication. Both were aware of the supervisory incident, i.e., responsibili previous incident, failed fulfill his Waldrop ties, including Juris, duty supervise plucked which an inmate had out one duty to eyes, severely review David’s clinical injured eye, course a his the other violative of restraint form forth what sets after losing testicles both his scrotum cut that the stated Although Romeo of Romeo. in discontinued first psychiatrist same institu a state patient mentally retarded failed medication psychiatric mate’s freedom liberty interest did have tion Wal See medications. one reinstate id., restraint, 457 U.S. bodily Thus, does Greason drop, 871 F.2d to note 2458, went on Court the at violat 102 S.Ct. conduct Mazick’s Dr. that indicate not not absolute. liberty was interest that that the Constitution. ed the Rather 319, 102 S.Ct. Id. at supervisory alleged ” Dr. Maziek’s are Nor “ had to the individual’ of ‘liberty interest George v. in to those comparable “ failures organized of ‘the demands be balanced (Ala.1991). McIntosh-Wilson, 1058 So.2d 582 ” Wolfish, 441 Citing v. Bell Id. society.’ mentally retarded severely that ease In 1861, 1874, L.Ed.2d 60 99 S.Ct. U.S. unattended was left he when patient died that indicated (1979), the Romeo 447 left within glove a rubber choked instance, could detainees, for pre-trial while that concluded the court case In that reach. detain pre-trial restraint of punished, be not the administra that infer could finder fact govern legitimate to “reasonably related ees informa duty to disseminate her failed tor pun not tantamount objectives and ment em direct-care non-professional to the tion Romeo, 457 U.S. at upheld. ishment” was dangerous patient’s the ployee regarding further The Court at 2460. 102 S.Ct. mouthing habit. be left balancing would that indicated Maziek Dr. judgment that the assert also appellees professional The only make viola- need courts the constitutional that for responsible members and prac- was exer judgment seclusion professional in Eufaula’s that inherent tions certain never conditions in Romeo Finally, the “inhuman Court tices, the specifically cised. in which case manner that the used in as the restraints building well 112” indicated were process restrictions patient’s forms of due other out and time were violative prac- other allege that these cited have appellees appellees rights.46 used. Romeo. sort forth law set indicate tices violated which would cases legally. factually and violate David’s fails would claim both here Their used restraint Plain bodily restraint. to be free right 112, appel Building respect With proposi merely abstract have relied tiffs sets specifically evidence cite no lees Alabama v. in Lassiter tions, the court which Al inhumane. conditions were Trustees, that the forth 28 University, Board MA & that seclusion allege appellees though (en banc), Cir.1994) (11th 1146, 1150 F.3d effect, none therapeutic had no Building 112 clearly insufficient. held that con support they cite the documents by the cited documents Rather clusion. allege Dr. Maziek also Appellees reforms merely indicate appellees actions taking remedial responsible seclusion respect to Eufaula’s necessary with Eufaula. and abuse beatings halt appellees have Nor system. restraint admin held that have eases Eleventh Circuit indicating that testimony expert presented abuse abate violence failure istrators’ Building 112 constitut used restraints See, indifference. deliberate may constitute judg professional to exercise a failure ed 1579 F.3d County, 50 Tallapoosa e.g., Hale v. time respect to argument with Their ment. vio (where Cir.1995) on inmate inmate (11th fails for forms restrictions and other out overcrowding and during regular lence reasons. same medi enough require severe it was where on oc hospitalization and even cal attention A con- legally. also fails claim Appellees Turner, F.2d 995 casion); LaMarca Bmlding use of elusory allegation — cert, denied, U.S. Cir.1993), (11th 1535 in- facility Romeo violated 112’s seclusion (1994) 1189, 127 L.Ed.2d -, 114 S.Ct. that more sufficient, precedent absent bound the apparently restraints of soft physically re- use Romeo, patient was only. through the arms day portions of each during strained (where, prison unnecessary psychology, psychiatry, context trained in or social pain suffering by work, standard is satisfied Dykes thus was not a mental health “unjustified expo- constant and unreasonable professional. Nevertheless, as an adminis violence”). However, sure the evidence supervisor, trator or he would liable if presented by does not indicate participated in the constitutional violation apprised Mazick was of an extent of if a causal connection existed between put violence and abuse which would him deprivation. actions and the constitutional on notice that his act in failure to the face of Dep’t. Cross v. Alabama Mental Health & such abuse and violence would rise Retardation, Mental Cir. level of a constitutional violation. 1995). respect allegations With that abuse First, appellees Dykes contend that rampant Eufaula, appellees was at failed to make sure David was from free presented as evidence of the affidavits John unnecessary restraints, i.e., bodily that he Billy Kirby Fowler and as well as the testi- practice allowed the of restraining patients mony of Kirby Forte. The affidavit of did punitive therapeutic than pur rather allege that Dr. Mazick knew about the beat- poses, and that he allowed ings. Specifically, the use of Build Kirby that stated ing 112 complained Dr. for seclusion. For Mazick that the reasons dis [the “all by being respect Mazick, residents] cussed above with were hit to Dr. members this including ... allegation David ... and lots of others.” must fail. However, we do not that believe this limited Second, appellees allege Dykes that

information support finding would that vi- failed to make expe sure that David did not rampant olence and abuse were so that fail- Although, Kirby’s rience abuse at Eufaula. ure react clearly-es- would constitute Dykes affidavit asserts that he told tablished constitutional violation. Plaintiffs beatings children presented received at the also hands evidence abuse and vio- residents, staff or allegation other Advocacy lence the FY 1991-92 must Monitoring fail Report. report, for the supra That for the reasons set forth reasons dis- in our I, swpra allegation cussed provide at Part did not discussion of this respect suf- physical ficient evidence to indicate that Dr. Mazick. jury was abuse such that a could infer that Third, appellees Dykes contend that Dr. Mazick knew that abuse vio- violated rights by constitutional fail rampant. report only

lence were con- ing to make sure conditions at Eufaula investigations cluded that incident were in- safe, among things, only by failing other adequate; it to re allegations detailed few move the bars Thus, dormitory and none from the had been closets. substantiated.47 Dykes We reasonably we do not first note that clearly believe that the case could law rely established that a on professional subordinates to ensure that a child possessing knowledge who doing Dr. Mazick risk of harm to himself had would have known that his placed actions vio- would be on close or continuous obser lated David’s rights. constitutional vation precautionary or that other measures might be taken. importantly, More we find Anthony Dykes

E. indicating no case Dykes law violated Anthony Dykes clearly was the director of the established rights.48 constitutional Dykes Eufaula Adolescent Greason; Center. was not This is distinguishable case jury might 47. A infer that Dr. Mazick had City Foley, In Belcher v. 30 F.3d 1390 plight learned of the of the resident discussed in 1994), Cir. this circuit held that it was not Forte’s affidavit. Forte testified that one resident official, jail established that "a reasonable who hospital had for ly taken twice to be treated knew hang by tying that an could inmate himself injuries incurred when residents sexual- other jail-cell some material to the bars of a door and However, assuming abused him. even yet prevent possibility, who failed also, Mazick knew of these two incidents acting with deliberate indifference to an inmate’s totality of what he knew does not create an taking of his life.” Id. episodes inference that the of abuse at Eufaula rose the level discussed the text. by Joint Ac- cilities Commission non-professional administrator there Hospitals....” no creditation of Id. That he took corrective liable because held mandate, however, not mean lack action, notwithstanding having specifi- does been per is a constitutional particular or accreditation se defects cally put on notice proposition be ano- facility.49 the sit- violation. Such would Unlike inadequacies malous, surely clearly-established Greason, is not of earlier no evidence uation law. injury involving alleged inad- constitutional incidents of closets, i.e., dormitory in the equacy, the bars Finally, appellees contend that presented. Dykes and subordinates such a exhibited Fourth, appellees also contend policies degree of indifference to the David had certain that Dykes failed make procedures that the staff could not have care, adequate specifically, adequate medical professional judg based their decisions adequate treat individual psychiatric care George policies. ments embodied See opportu give him realistic as would ment McIntosh-Wilson, 582 So.2d improve his medical nity to be cured or (Ala.1991) (“[P]olicy-making administrators However, is no indication there condition. depriva for the constitutional would be liable David’s histo Dykes knew the details of they if their subordinates tions caused ry gestures or or that threats of suicidal degree of indifference to exhibited such specific behaviors Dykes knew about policies compliance with as to demon their Moreover, at Eufaula. exhibited while they that did not base their actual strate Dykes in complaints this appellees’ about administrative decisions actions abstractions, readily rely we regard which professional judgments poli embodied Lassiter, 28 insufficient. See conclude are However, expert cy.”) appellees’ neither at F.3d 1150. other evidence the record affidavit nor policies were violated as a indicates which Dykes Fifth, appellees argue that appellees do Dykes’ result of failures.51 Nor steps no to insure that Joint Commis took clearly identify the established constitutional Organizations on Accreditation Health sion policies. rights implicated readi such We (“JCAHO”), as re was attained accreditation ly appellees that have failed es conclude quired Wyatt Decree as under Consent alleged these deficiencies on the tablish that Wallis, Wyatt approved in v. amended and Dykes clearly part of violated David’s estab (M.D.Ala.1986). 69194, We need WL *6 1986 Lassiter, rights. 28 constitutional lished can in a consent decree address whether at 1150. clearly the con establish other circumstances law,50 in this case we hold stitutional because Emmett Poundstone F. any nor neither the Consent Decree that was ADMHMR clearly Emmett Poundstone precedent a consti other established Health. for Mental As Associate Commissioner right to accreditation. tutional JCAHO scope measures, facility within Wyatt Eufaula many The remedial one responsibility. Poundstone required officials Poundstone’s Decree the state Consent professional. full was not mental health make efforts achieve “to all reasonable failed to claim that Poundstone mental health fa- accreditation Alabama’s (5th May case, Mississippi, Cir. A facility F.2d 1142 Unit Kemp, 644 the warden of the In that Norris, 1981). suicide, Long 929 F.2d 1111 See also v. knew of where an inmate committed Cir.), (6th Long, inadequacies facility sub nom. Jones v. but cert. denied particular in his did 187, 116 L.Ed.2d 148 nothing U.S. 112 S.Ct. them knew a similar to correct McKaskle, (1991); nothing 788 F.2d 1116 previously Green v. but did had occurred incident Cir.1986). prevent investigate previous it incident or Greason, again. happening 891 F.2d policy alleged 51.Although that Eufaula’s it 839-40. admitted in contra- violated when David was Evans, against admitting actively policy vention of the 840 F.2d 880 n. 50. See Clark v. Bennett, patients, alleged Dykes (11th Cir.1988); took it is not 689 F.2d suicidal Williams v. denied, directly (11th Cir.1982), part or that he could be in that decision cert. 464 U.S. (1983); implicated in that decision. 78 L.Ed.2d 305 Jackson 104 S.Ct. Lassiter, Appellees make sure the Eufaula 28 F.3d do recog- specific King’s trained suicide make a contention assessment about defi- nizing readily respect Wyatt suicidal tendencies. We con- ciencies with Consent Decree, i.e., claim an clude this has no merit. Where acquire failure Eufaula to profes- However, institution is staffed with health care JCAHO accreditation. this claim sionals, including psychologists, psy- IV.E., licensed for stated in Part fails the reasons workers, appellees chiatrists and social we know of no supra. allege King also in this cases indicate that circuit being knew that children were un- secluded failure of a state-wide administrator to make improper der conditions and failed to take provisions training such for the mental action. For the set in Part reasons forth IV.D., professionals care supra, health constitutes viola- argument also fails. tion of established constitutional rights.52 V. CONCLUSION margin, remaining As noted reasons, the'foregoing For affirm we by plaintiffs against claims fail Poundstone summary judgment district court’s denial of already

for reasons discussed.53 Juris, as to Karen we reverse the court’s summary judgment denial of as to the re- Royce King

G. maining appellants. Royce King was ADMHMR com AFFIRMED IN PART and REVERSED profes missioner. He is not a mental health PART. IN appellees allege King sional. The degree

his subordinates exercised such compliance indifference EDMONDSON, Judge, dissenting Circuit policies they ADMHMR that not did base part in in concurring part: and the in result actual pro their administrative decisions on great today’s opinion right. A of is I deal However, judgment. appellees fessional the concur, however, cannot in the decision on particular King do not indicate which policies Karen Juris. ignored. appel- and subordinates doNor identify clearly-established my lees the judgment, constitu In when Ms. in Juris 1992 rights implicated by policies. act, tional already such or acted failed to it was not Thus, readily we appellees clearly conclude that a of established as matter law that failed rights, to demonstrate a violation of the under the fourteenth amend- clearly clause, rights. established process constitutional ment’s patients See due of mental Greason, failings In prevent numerous combined to attempts. suicidal tendencies and suicide persuade deny qualified only immunity alleged deficiency the court to merely Not was that one Duncan, deficiencies, position who held the state-wide of of of number more serious the against Georgia Director of Mental Health for the instant claim Poundstone De- is that he partment provisions knew that Corrections. Dr. Duncan was aware Eufaula’s for suicide assess- previous wholly inadequate, very the Waldrop of dent, and ment were but he similar inci- rather that merely psychiatrist pri- policies failed to ensure that were aware that the same there requiring marily responsible training. readily Waldrop We for the more conclude incident was wholly Greason, precedent inapposite. that the only psychiatric Greason is the source care for adequately was aware that he could not all treat care, requiring of the inmates mental health 53. The contend that Poundstone is not particular aware that the no institution made (1) summary judgment entitled to because provision all at for mental health treatment stop beating failed to take measures the and general plans, and in was aware of the condi- Eufaula, (2) change abuse he failed to grossly tions at the that institution constituted allegedly unconstitutional seclusion and time-out Nevertheless, inadequate mental (3) health care. policies, and he failed to that ensure Eufaula any Dr. Duncan failed to take remedial action. acquired JCAHO accreditation. The first and Amongst the claims of Dr. Duncan's deficiencies allegations second fail for reasons set in forth to, actually superficially claim similar but in Section IV.D. our discussion of this claim with claim—i.e., much different from the instant respect Bradley that Mazick. The third claim fails Dr. Duncan knew that the institution had no for the set in reasons forth Section IV.E. in our policies procedures designed help or respect Anthony the non- discussion of this claim professional prison guards recognize Dykes.

1057 that the never has also held way, this Circuit insti to state civilly committed involuntarily always, patients rights of mental process due as same always be the tutions would rights eighth amendment least, equal amendment, of con eighth under rights, Therefore, today’s court’s prisoners. circumstances if the even prisons in victs eighth Greason —an heavy reliance Therefore, I cannot similar. otherwise the case decision—as amendment (and every reasonable Juris Ms. agree that rights clearly already established 1992 expected place) would be her worker social prison amendment’s eighth outside F.2d Kemp, that Greason to know along. go I shaky. cannot too context seems Cir.1990) case decided (11th prison —a estab grounds clearly amendment eighth — Greason, words me, light of in the For governing the rules of law a matter lished Romeo, suggest does quoted I have under the prison aof outside conduct her law that the decide might ultimately courts amendment. fourteenth workers outside health requires mental eighth exceed to follow prisons some prison between The difference Lassiter, But, we guidelines. amendment difference and the of institution kind other something suggest precedent for said the four- eighth amendment between enough. just not applicable law about clause are process due amendment’s teenth To least, question. to cloud enough, at dictate, law must “pre-existing said the We not to prison is of a outside apply Greason (not just suggest or is, truly compel I do not Greason, it. to extend but follow about), conclu question allow or raise such nonlawyers must foresee believe like-situated, gov every for sion me, To immunity. or forfeit their extensions doing defendant agent that what ernment idea face of the flies practice law the circumstances.” federal violates personal against immunity protects University, Bd. MA & v. Alabama Lassiter violated acts the defendant’s liability unless Cir. Trustees, pre-existing law. banc) original). established (en 1994) (emphasis in the in Romeo Supreme Court view, (and I know my Greason did civilly persons things that among other not) wrote law, truly dictate could as a matter considerate to more are “entitled committed Karen Juris conclusion essential than of confinement and conditions working treatment outside her who like those of confinement conditions whose to a criminals this social worker hold cannot prisons. I those words But punish.” designed particular- are understanding of clearer law— They explain holding of Romeo. authority not are Greason— precedential ly they explain part: decision the Romeo I have. than standard indifference” why the “deliberate Juris, for Karen result from the I dissent adopted for mental was not prisons used for otherwise. in the result concur but hold does Romeo not But institutions. eighth amendment every that violates act doubtlessly violate will prisoner

rights of involuntarily those rights of process due my institutions. to state

civilly committed aas established

view, idea so established was not now and of law

matter

in 1992. Supreme Court’s say that

I do not totally without quoted are I have

words that pre- value they some

significance; do But, say the words I do

dictors. And, by the law, in themselves. establish Notes February dated Juris became members of David’s treatment 4, Juris indicated that David presented and, team such, as signed David’s master extremely as irrational during previous plan. treatment plan noted, treatment week; she added that he was not out of touch among things, other that David suffered an reality. On the afternoon of day, active suicidal ideation gesture problem, injured himself, creating an ulcer one prescribed and it weekly, thirty-minute indi- centimeter in diameter on his left wrist. On vidual therapy sessions as well a weekly February 13, a staff member reported that forty-five-minute group session. David wrote with a rock on the security David exhibited self-destructive behavior screen window, over “Oh, God I want to Eufaula, while at including making die, suicidal please take me or I’ll suicide, commit partment of Youth Program Services in Mont- 8. Evidence in the record below indicates that gomery, Alabama. grandmother David’s er, suicide; committed howev- portion of David's Eufaula record which 5. The district opinion he indicates discusses the gives incident the impression that admitted on this date in appears but this grandmother David’s father's committed suicide. have been a typographical error. 9. "He denies time; hallucinations at this howev- 6. According record, appellant Mazick, er, very in a detached manner he describes look- director, Eufaula clinical did not see David ing in the seeing mirror and reflection, no seeing point. hands beckoning seeing him and ghost someone killed a car wreck.” 7. David during told Juris her initial interview with him that he had attempted suicide ten 10. apparently nurse give refused to him times, that he gesture made his first in the fourth pain. medication for Progress In his Notes Juris grade. He also described attempts wrote, other “He claimed upset Nursing because had occurred years within two of his arrival at provide did Services treatment to a small However, Eufaula. appears Juris to have puncture been on his hand.” In her suicide assess- skeptical about whether attempts these ever oc- ment of David conducted the following day, Juris curred or at least the nature of attempts. wrote: "I interviewed him on 1/27/92 and question “There is some as to perva- the actual appeared nondepressed and denied all suicidal siveness of thoughts [suicidal] and whether ideation. He was verbal and animated. David

Notes

Notes Progress David’s in to close status change his ever, did Juris talking about of value” “shock enjoy the to checks. minute with fifteen observation suicide. not was status Thereafter, his observation cut p.m., David 2:45 about at8 March On 24. morning March of until the again changed mem- A staff metal. of piece awith armhis “fail- for was secluded David On March Prog- in David’s incident described ber and bleeding on walls rules, follow to ure dorm in the I arrived “When Notes: ress room. time-out floor” defecating on left his and in the bathroom standing was spit blood to secluded, David continued Once running, bleed- sink H2O arm area. seclusion the walls on arm....” his left to a cut ing profusely room. emergency in his pencil taken stuck was David David On March and, as indicat- again taken stitches ten required was 8. He cut of March wound Nixon, having assessment suicide David’s room. emergency Juris ed vertical, wide due his self-inflicted “fairly lethal for form, twice was David treated blood.” excessive evalu- be David of loss requested possibility March cut wound wrote, “This She psychiatrist. by a ated day, David the same p.m. 4:45 Around anti-psychotic for be evaluated child MUST told He teeth. his with sutures removed David arranged for Juris medication.”13 to kill going was “he nurse Eufaula day. next Dr. Jenkins see have sutures going to he was himself could a child meant apparently which performed affidavit, that she said she Juris' except to room dormitory or his dorm his leave denied David assessment risk a suicidal could members Staff meals. classes attend as- however, intent; suicide is no there suicidal required which "time-out" place children also respect to this with record form sessment awith room particular ain confined children incident. every fifteen them Eufaula, checking on member staff During time his minutes. Kirby, Billy Fowler John affidavits hours. approximately for kept time-out residents, also in- Eufaula fellow two of confinement, an serious more was a Seclusion for seclusion placed in David was dicate Eufaula Residents measure. extreme indicate records His removing sutures. building individually ain secluded apparently for failure but March secluded he was three one dormitories separate from instructions. follow jail cells bare resemblant rooms small only incident is not This floors, heat. and ño furniture no concrete sent injury, David Before was secluded. file that in David's noted Nixon It 14 hours. 13.Dr. of about total for a seclusion of self-mutila- episode the third place 18 incident at Eufaula practice common apparently (including attention her had come tion which confine- forms in various disruptive child stitches). 8March of his the removal restriction being dorm ment, version milder

Notes closet door hinges off its March 24 that he “continue[d] knocked a hole resort to in it. self- David told the injurious behavior angered worker when frustrated," that he had swings mood and felt like might but destroying something. referred to his behavior of March 19 (sticking pencil wound) in his wrist 16. The seclusion order indicated that the reasons or his behavior of March 21 (threatening to cut for seclusion physical were David’s aggression himself).

Notes seclusion in Greason. that on both March 23 indicated corded on secluded, 21 March David was violation on the constitutional Because do harm to himself. part, attempting

notes Dr. Jenkins’ Eufaula. every patient up on follow cursory. Dr. record, are in David’s recorded a resident after indicates contract David’s reviewed he had wrote Jenkins obligat- only admitted, psychiatrists therapist, nurse case per- in order patients up on follow toed in self-destructive engaging been reviews.30 medication form past no current behavior, there do duty to did have psychiatrists “alert” psychosis, evidence ini- diagnoses evaluations, initial intake orderly, thought was “oriented,” his psychi- provide plans treatment tial memory and indifferent, affect it Thus consulted. when services atric concluded, “This Jenkins intact. intellect each how to examine us upon incumbent be behavioral.” difficulty seems upon when called performed psychiatrist

notes the examination as evidence Halpern’s Dr. affidavit suffers from several any that Dr. Jenkins not testing did do in- or flaws. depth Finally, plaintiffs evaluation. con- tend that First, Dr. Jenkins also failed to have the Halpern Dr. was not careful to psychologist, Maziek, Ph.D. Dr. for Maughon see David Dr. sepa discuss and Dr. Jenkins in-depth more testing. Instead, rately. Halpern often referred Halp Apparently, standard, 32. both the legal and Dr. the relevant will be of little assis- expert in his affidavit are See, confused about Evans, e.g., Rogers tance to a ern which court. psychiatrist was involved in the March 19 (11th Cir.1986) (approving 1062 n. 9 and March 21 incidents. The defendants note striking lower court’s order affidavit of medical Jenkins, Maughon, that Dr. David on not Dr. evaluated expert "phrased where the affidavit was in con- Maughon, March 19 and Dr. not Dr. clusory citing terms without facts" and conclud- Jenkins, prescribed tranquilizer the Vistaril ing that the affidavit was "defective create a March dispute"). factual However, expert opinion merely an which is conclusory, even language if couched in the And, help expert from tially he left with little David. when treatment” of “their comparing binding the facts of this case with individually, Halpern them Dr. did discuss precedent roles in their treat which sets forth contours of the two doctors’ confused David; our in this area. his affidavit indicates law ment on March 19 Maughon Dr. examined say Halpern’s is not that Dr. This prescribed for Vistaril and Dr. Jenkins wrong. say conclusions are Rather it is to it in fact was Dr. Jenkins on March when that his us in our affidavit does not aid on March 19 performed who the examination qualified immunity analysis. His affidavit is Maughon call on and Dr. who received the any kind of tool which indicates with Also, Halpern assumes that March 21. Dr. specificity degree to which doctor Eufaula psychiatrists under contract with strayed accepted here from the realm of duty manage up on and follow each professional judgment. that Dr. The fact discussed, patient. supra, As Medical Mon departure Halpern phrase used the “total Management’s not call for ey contract did judgment, practice stan professional from any part of the record that34 nor does other dards, it their such that cannot be said that consulting arrangement or that the indicate accepted of David was based on treatment required moni accepted medical standards psychiatric prac professional judgment toring any patients follow-up aside summary judgment tice” does not foreclose receiving patients those medication.35 from qualified immunity properly when has been agreement terms of the indicated help must the court to raised. affidavit depend on the psychiatrists could purported departure discern whether bring to professionals to their mental health that, light report egregious was so indicating psy problems a need attention cases, professional ed a reasonable would Finally, Halpern’s Dr. chiatric intervention. recognized behavior amounted helpful establishing was not affidavit to a constitutional violation. allegedly degree to Dr. Jenkins had which departed accepted medical standards. Application Prior Law d. Case Halpern’s does refer to three Dr. affidavit analysis first on the Our here will focus suggests indicated need incidents plaintiffs’ assertion that Dr. Jenkins failed to intervention—the for more intensive Febru- and treat David after the adequately assess ary incident in which David was found pencil March 18 incident when David stuck himself, talking to the March 8 incident when self-inflicted wound. Dr. his March 8 sutures, and removed the David cut himself Jenkins David on evaluated when David was and the March 15 incident day following Dr. Nixon’s note David’s defecating on the bleeding on the walls indicating psychiatric for a the need record Halpern floor of room. Dr. the time-out anti-psychotie evaluation for medication. only expressly one these incidents labels He psychotic behavior. does state inquiry into Dr. Jenkins’ Relevant our why these incidents are so serious as March 19 is the fact that behavior on therapy require medication or more intensive Jenkins indicates that he reviewed eonclusory authority he cite for his nor does Thus, taking prior examining him. record

notes Halpern, expert, tiffs’ rise would facts which find reasonably could suicide, made had history of family clearly estab violation aof level sug- attempts, and threats prior suicidal law. lished alleged fail- rights, follows it stitutional on March actions If Dr. Jenkins' violate did8 on March action to take incidents ure more privy to several point he law. psychotic constitutional possibly clearly established self-destructive David's behavior, con- clearly established violate did not

Case Details

Case Name: Dolihite v. Maughon

Court Name: Court of Appeals for the Eleventh Circuit

Date Published: Jan 23, 1996

Citation: 74 F.3d 1027

Docket Number: 94-6343

Court Abbreviation: 11th Cir.