Jerry Richard Jensen filed an action for damages pursuant to 42 U.S.C. § 1983 for unlawful arrest and restraint against Lane County, certain officials, a hospital, and a private medical practitioner, Jeffrey M. Robbins, M.D. The district court granted summary judgment in favor of Dr. Robbins, and the other defendants went to trial, where the jury found in their favor. The only issue on this appeal is whether Dr. Robbins was entitled to summary judgment.
PROCEDURAL HISTORY
The magistrate judge to whom the motion for summary judgment was assigned based his recommendation on two alternative grounds. First, he concluded that the doctor’s conduct in signing a commitment order did not constitute “state action.” For reasons that will be developed below, that was incorrect. In the alternative, the magistrate judge concluded that, if Dr. Robbins’ conduct was state action, Dr. Robbins was entitled to qualified immunity. The district court adopted the magistrate judge’s recommendation and later denied Jensen’s motion to reconsider.
FACTUAL HISTORY
Shortly before midnight April 15, 1995, Jensen was arrested for “menacing with a firearm” after he pointed a gun out of his car window at a pedestrian. Officers apprehended Jensen and deemed it necessary for their safety to handcuff him. The officers found a loaded automatic handgun and an open can of beer in the vehicle. Jensen was uncooperative, smelled of alcohol, and had an unsteady gait. Jensen told the officers he was taking various medications for conditions including depression. Jensen was booked at the Lane County adult corrections facility (“LCAC”).
On April 17, two days after the arrest, Richard Sherman, a senior mental health specialist employed by Lane County, received information from the jail that Jensen’s work supervisor, Putschler, who was also a county employee, had called to report serious concerns about Jensen’s recent behavior, which included: bringing a gun to work, commenting empathetically about “post-office” shootings by disgruntled employees, and drinking alcohol. Put-schler reported that co-workers had felt threatened by these actions. Putschler’s report resulted in his being named as one of the defendants who was later exonerated by the jury.
Sherman reviewed Jensen’s arrest documents and other jail information and met with Jensen. After this meeting, and in light of the information previously obtained, Sherman concluded that probable cause existed to believe that Jensen was a danger to himself or others because of depression, paranoia, and aleo-
LCPH is a county facility that has a contract with private Sacred Heart General Hospital (“SHGH”) under which the hospital provides administration and hospital staff to the county. On April 17, relying on police reports and the information obtained from Sherman, but without personally examining Jensen, Dr. Robbins signed the order detaining Jensen for evaluation pursuant to Oregon Revised Statute 426.232.
On April 18, 1995, Dr. Robbins took a history and performed a physical examination of Jensen. Dr. Robbins’ notes from that day indicate a diagnosis of “Major depression in remission with Zoloft,” alcoholism, and a “probable paranoid personality disorder.” Jensen did not cooperate in the examination, so Dr. Robbins again relied heavily on police reports and information obtained from Sherman in deciding to continue Jensen’s detention pursuant to Or.Rev.Stat. § 426.282, which permits temporary mental health detention for a period not to exceed five judicial days. Thereafter, Dr. Robbins saw Jensen briefly on each of the next three days.
While Jensen was at LCPH, Dr. Ekan-ger conducted an investigation to determine whether to pursue statutory involuntary commitment proceedings before the court. Dr. Ekanger concluded that there was insufficient evidence to proceed. Dr. Robbins agreed that Jensen was no longer mentally ill and should be released. Dr. Robbins’ notes state: “No evidence of mental ihness seen during stay here. No dx made. MMPI [a psychological test] not yet available. D/C [discharge] to LCAC [the jail].”
Jensen was released from LCPH on April 21, 1995 (the fifth day of his detention for evaluation). Dr. Robbins told Jensen at that time that he (Dr. Robbins) had been prepared to release Jensen “a couple of days ago.”
. Jensen then filed this action pursuant to § 1983 alleging that Dr. Robbins and the other named defendants had violated his constitutional rights by ordering him admitted to LCPH without due process of law. Jensen also asserted, remembering Dr. Robbins’ comment at the time of his release, that the defendants violated his rights by continuing his involuntary detention beyond the reasonable time when the defendants, including Dr. Robbins, could no longer have had probable cause to detain him. Because Dr. Robins had been removed as a defendant by the summary judgment, the questions that went to the jury trying the claims against the other defendants were not reached with respect to Dr. Robbins. However, the jury in its special verdict found that there was probable cause to believe that Jensen was a danger to himself or others during the entire time that he was held at LCPH, but that there was not probable cause to believe that he was mentally ill for the entire time. The overall verdict was nonetheless rendered in favor of all defendants (except Dr. Robbins) after the jury had been properly instructed. Jensen now wants a jury to scrutinize Dr. Robbins’ role in his detention.
STANDARD OF REVIEW
This court reviews a summary judgment as a question of law (de novo). See Smith v. Hughes Aircraft Co.,
Section 1983 of Title 42 provides:
Every person who, under color of any statute, ordinance, regulation, custom, or usage, of any State ... subjects, or causes to be subjected, any citizen of the United States or other person within the jurisdiction thereof to the deprivation of any rights, privileges, or immunities secured by the Constitution and laws, shall be liable to the party injured....
Jensen alleges that his involuntary commitment constitutes a violation of his rights under the Fourth and Fourteenth Amendments. Because § 1983 and the Fourteenth Amendment are directed at the states, the statute supports a claim only when the alleged injury is caused by “state action” and not by a merely private actor, against whom tort remedies may be sought in state court. The Supreme Court has warned that “[cjareful adherence to the ‘state action’ requirement preserves an area of individual freedom by limiting the reach of federal law and federal judicial power.” Lugar v. Edmondson Oil Co.,
Therefore, in order to prevail under § 1983, a plaintiff “must show (1) that Defendants deprived [him or] her of a right secured by the Constitution or laws of the United States and (2) that, in doing so, Defendants acted under color of state law.” Okunieff v. Rosenberg,
The district court, as noted, did not believe that Dr. Robbins’ conduct constituted “state action” and therefore excluded him as a defendant within the scope of § 1983. This court has not had occasion to rule on whether contract services provided by licensed private physicians to municipal governments in the detention and examination of persons brought into treatment facilities by police officers as possible mental patients constitutes state action within the meaning of § 1983. On the facts of this case, we hold that Dr. Robbins was a “state actor” for the purposes of being a defendant in a § 1983 action.
Courts have developed various tests for determining whether an individual’s actions are “state action.” See Sutton v. Providence St. Joseph Med. Ctr.,
When purely private actors obtain the help of a private physician to bring about the involuntary admission and detention of an allegedly mentally ill person for psychiatric examination, courts that have addressed this scenario in the § 1983 context have held that there is no state action. See Okunieff,
Blum v. Yaretsky,
Dr. Robbins asserts that Blum is directly analogous. He argues that, by contract and in practice, it is the committing physician that must make the medical judgment under which a person is detained for a psychiatric evaluation. Indeed, the statutory obligation of the physician is to order the detention of those persons whom he or she believes to be a danger to self or others.
In order to be considered state action, when a private actor participates in a governmental act, the court must find a sufficiently close nexus between the state and the private actor “so that the action of the latter may be fairly treated as that of the State itself.” Jackson v. Metropolitan Edison Co.,
The record is clear that Dr. Robbins and the County through its employees have undertaken a complex and deeply intertwined process of evaluating and detaining individuals who are believed to be mentally ill and a danger to themselves or others. County employees initiate the evaluation process, there is significant consultation with and among the various mental health professionals (including both PA psychiatrists and county crisis workers), and PA helps to develop and maintain the mental health policies of LCPH. We are convinced that the state has so deeply insinuated itself into this process that there is “a sufficiently close nexus between the State and the challenged action of the [defendant] so that the action of the latter may be fairly treated as that of the State itself.” Jackson,
Although this case falls between lines drawn in other jurisdictions and presents an issue of first impression for this court, under the close nexus/joint action test, we
QUALIFIED IMMUNITY
The doctrine of “[qualified immunity strikes a balance between compensating those who have been injured by official conduct and protecting government’s ability to perform its traditional functions.” Wyatt v. Cole,
As a preliminary matter, a finding of “state action” on .the part of Dr. Robbins does not require this court to find that he is entitled to qualified immunity. See Richardson v. McKnight,
There are two questions that must be answered with respect to Dr. Robbins’ claim of qualified immunity. First, we must determine whether qualified immunity is categorically available. This requires an evaluation of the appropriateness of qualified immunity given its historical availability and the policy considerations underpinning the doctrine. See Richardson,
We first address the categorical availability of qualified immunity. The Supreme Court in Richardson analyzed the availability of qualified immunity by looking to history and policy. Although § 1983 “ ‘creates a species of tort liability that on its face admits of no immunities,’ ” Wyatt,
In Richardson, the Court held that qualified immunity was not available to privately employed prison guards because the Court was unable to identify a “firmly rooted” tradition of such immunity.
Limited information has been presented on the historical availability of immunity for doctors asked by the government to make a decision to commit persons suspected of mental illness.
Dr. Robbins argues that the State of Oregon has provided for immunity from criminal and civil liability when an individual acts pursuant to Oregon’s involuntary commitment statute, so long as the person acts in good faith, on probable cause, and without malice. Or.Rev.Stat. § 426.280(5).
This statute’s current legislative history indicates that the statutory immunity at issue in this case first appeared as an amendment in the 1987 Session Laws.1987 Or. Laws, vol. 2, ch. 903, § 31 (amending Or.Rev.Stat. § 426.280 to include immunity provisions, of Or.Rev.Stat. § 426.280(5)); cf. 1985 Or. Laws, vol. 1, ch. 242, § 5, (amending Or.Rev.Stat. § 426.280 but including only immunity for state medical officers in the context of trial visits). The legislative history is very sparse. We have found no committee reports or legislative comments directly pertaining to this provision. We have been unable to uncover even a suggestion that Oregon has a “firmly rooted tradition” of immunity, which Congress would have abolished explicitly had it intended to do so. The parties have provided us no information on the historical foundations of the statute, nor anything to convince us that a 1987 Oregon statute, without more, can provide the “firmly rooted tradition” that the Supreme Court requires. Moreover, the parties have not offered, and we have not found, any definitive common law history of immunity outside of Oregon that would support a finding of qualified immunity here.
The next step of the analysis requires us to examine the policy justifications for qualified immunity. The chief justifications for qualified immunity include: (1) “protecting the public from unwarranted timidity on the part of public officials” and “ ‘encouraging the vigorous exercise of official authority.’ ” Richardson,
This case is similar to Richardson in many respects. PA is a privately organized group of psychiatrists providing services to the government pursuant to contract. The privatization and market forces arguments are equally applicable here as well. PA psychiatrists must provide psychiatric services for the County with the market threat of replacement for failure to complete their duties adequately. As in Richardson, the potential for insurance, indemnification agreements, and higher pay all may operate to encourage qualified candidates to engage in this endeavor and to discharge their duties vigorously.
In Halvorsen v. Baird,
In the instant case, concerns about timidity are moderated by the likelihood that PA’s failure to adequately complete the commitment and psychiatric care duties for which it has contracted will lead to its replacement by competitors. Likewise, the threat of liability can be overcome by private firms subject to market forces through such devices as monetary incentives, insurance, and indemnity agreements. If the state finds that the threat of liability is deterring talented private doctors or doctor groups from contracting with it, the state can raise compensation levels and provide other incentives to maintain high levels of quality participation in this joint undertaking. These are exactly the market forces contemplated in Richardson and Halvorsen.
Dr. Robbins has not presented evidence that these market forces are inapplicable or inadequate here, but instead attempts to distinguish Richardson on the ground that, unlike the prison management firm,
The Lohiser case held that a private foster care contractor and private social workers who contracted with the state to provide a recommendation about whether a mother was fit to parent were entitled to qualified immunity. See id. The court held that the defendants were private persons performing a discrete public service task at the express direction and under close supervision of governmental officials. See id. at 646. In Lohiser, the defendants had contracted to provide services with respect to discrete individuals. Id. at 643. Additionally, the private defendants in Lo-hiser were subject to active supervision and close monitoring, did not conduct any policy-making or administrative functions, and operated as a not-for-profit entity. Jd. at 643, 646. By contrast, PA conducts a number and variety of tasks over the term of a three-year contract. Particularly, PA is responsible for accepting referrals, making admission and discharge decisions, providing on-going psychiatric care, and participating in at least some hospital policy-making. Although no one of these responsibilities is necessary or sufficient to our determination, together they show that PA is engaged in a complex administrative task. Furthermore, there is no indication that the sendees provided by PA could be described credibly as “a discrete public service task.”
This leads to the “distraction” argument. In Richardson, the Supreme Court specifically noted that the threat of legal action creating a distraction for private individuals in a private firm is not an independently compelling factor.
We need not determine, and decline to speculate, whether Jensen is entitled to a trial in this case. We note, however, that § 1983 plaintiffs must allege and show a material issue of fact as to the existence of a constitutional violation. The magistrate judge found that “Dr. Robbins’ determination that probable cause existed to sign the certificate was reasonable under the circumstances and he did not violate clearly established law.” This at least
REVERSED AND REMANDED.
Neither party to recover costs on this appeal.
Notes
. Or.Rev.Stat. § 426.232 provides in relevant part:
(1) When a physician licensed to practice medicine by the Board of Medical Examiners for the State of Oregon believes a person who is brought to a hospital or nonhospital facility by a peace officer under ORS 426.228 or a person who is at a hospital or nonhospital is dangerous to self or to any other person and is in need of emergency care or treatment for mental illness, the physician may do one of the following:
(a) After consulting with a physician or a qualified mental health professional ... detain the person and cause the person to be admitted or, if the person is already admitted, cause the person to be retained in a hospital where the physician has admitting privileges or is on staff.
. The paucity of federal case law may be accounted for by disputes arising out of mental health commitments being brought in state courts prior to the enactment of § 1983.
. There is some authority indicating that physicians who signed off on emergency commitment orders were given absolute immunity. See e.g., Dunbar v. Greenlaw,
. Or.Rev.Stat. § 426.280(5) provides in part:
No physician, hospital or judge shall be held criminally or civilly liable for actions pursuant to ... ORS 426.232, 426.234 ... if the physician, hospital or judge acts in good faith, on probable cause and without malice.
. We do not foreclose the possibility that Dr. Robbins may be able to assert an affirmative good faith defense. See Richardson,
