Ralph PARTRIDGE and Betty Partridge, Plaintiffs-Appellants, v. TWO UNKNOWN POLICE OFFICERS OF the CITY OF HOUSTON, TEXAS, et al., Defendants-Appellees.
No. 83-2615.
United States Court of Appeals, Fifth Circuit.
Feb. 4, 1985.
751 F.2d 1448
IV. CONCLUSION.
We have examined each of Mattheson‘s claims and conclude that he is not entitled to habeas relief. Accordingly, the judgment of the district court is AFFIRMED and the stay of execution is VACATED.
E. Grady Jolly, Circuit Judge, filed dissenting opinion.
Mary Madigan Dinan, Asst. City Atty., Houston, Tex., for City of Houston and Houston Police.
D. Reid Walker, Houston, Tex., for Morris.
Before WISDOM, RANDALL and JOLLY, Circuit Judges.
WISDOM, Circuit Judge:
The question this case presents is whether the Eighth Amendment‘s prohibition against cruel and unusual punishment imposes a duty upon the state to protect prisoners (here detainees) from themselves. The parents of Michael Wayne Partridge brought suit under
I. FACTS AND PROCEEDINGS BELOW
The pleadings state the following facts. In February 1980, a Houston police officer arrested Michael Wayne Partridge on suspicion of burglary and theft.1 While the officer was investigating the scene of the alleged crime, Partridge became agitated and violent, and attempted to kick the doors and windows out of the car. The officer, who was working alone at the time, requested a two-man unit to transport Partridge to the jail. When the back-up unit arrived, Partridge was still kicking at the doors and windows. A sergeant at the scene asked Partridge‘s father if the boy had any “mental problems“. Partridge‘s father told the officer that the boy had suffered a nervous breakdown.
The two transporting officers, one of whom was Morris, handcuffed Partridge and drove him to the jail. On the way to the jail, Partridge intentionally struck his head at least once against the plexiglass divider between the front and back seats. Morris was able to calm Partridge, and by
The plaintiffs further alleged that suicide is a known risk at detention centers, that defendants knew or should have known of Partridge‘s suicidal tendencies, and that the defendants’ policies and procedures in adequately protected detainees from the risk of suicide.2 The defendants filed a motion to dismiss under
Upon the defendants’ motion to dismiss and the plaintiff‘s response, the district court held that the plaintiffs had failed to state a claim under the “deliberate indifference” standard of Estelle v. Gamble, 1976, 429 U.S. 97, 104, 97 S.Ct. 285, 291, 50 L.Ed.2d 251, 260. The court explained:
“In light of considerations established by the Court of Appeals for the Fifth Circuit in Woodall v. Foti, 648 F.2d 268 (5th Cir.1981), to determine whether the alleged denial amounts to deliberate indifference to the decedent‘s medical needs, it is the opinion of the Court that the plaintiffs’ claim is insufficient to state a claim for relief under
42 U.S.C. 1983 (1976) .”
This appeal followed.
II. DISCUSSION
A. The Standard of Review
The district court styled its action as a dismissal under
B. The Scope of Duty Under Section 1983
The Supreme Court has held that prison authorities have a duty under the Eighth Amendment to provide needed medical care for inmates, and that “deliberate indifference to serious medical needs of prisoners” violates the Constitution. Estelle v. Gamble, 1976, 429 U.S. 97, 104, 97 S.Ct. 285, 291, 50 L.Ed.2d 251, 260. Our Court has recently summarized the law on this point:
“The state has an ‘obligation to provide medical care for those whom it is punishing by incarceration.’ ‘[A]cts or omissions sufficiently harmful to evidence deliberate indifference to serious medical needs’ of inmates constitute cruel and unusual punishment.”
Ruiz v. Estelle, 5 Cir.1982, 679 F.2d 1115, 1149.
The defendants acknowledge that prison authorities have a constitutional duty to provide necessary medical care to inmates under Estelle, but contend that the duty does not extend to protecting inmates from themselves.4 We find, however, that the Eighth Amendment does reach some instances of deliberate self injury. This holding is consistent with the position taken by other courts of appeals and comports with our own precedents.
There is no sound underlying distinction between the right to medical care for physical ills and for psychological or psychiatric afflictions. See Woodall v. Foti, 5 Cir.1981, 648 F.2d 268, 272; Bowring v. Godwin, 4 Cir.1977, 551 F.2d 44, 47. Treatment of mentally disturbed inmates is a “serious medical need” under Estelle. Woodall, 648 F.2d at 272. The “deliberate indifference” standard of Estelle is therefore equally applicable to assessing the constitutional adequacy of treating psychological or psychiatric ailments at a prison.
Suicidal tendencies evidence a psychological or psychiatric condition that could be as serious as or more serious than any physical pathology or injury. And just as a failure to act to save a prisoner suffering from gangrene might constitute deliberate indifference, Bass v. Sullivan, 5 Cir.1977, 550 F.2d 229, 231-32, cert. denied, 434 U.S. 864, 98 S.Ct. 195, 54 L.Ed.2d 138, failure to take any steps to save a suicidal prisoner from injuring himself may also constitute deliberate indifference to a serious medical need. Such indifference might be manifested by failure to search adequately a medically trained prisoner who had repeatedly threatened to smuggle poi-
Defendants contend that the state cannot be liable in a
“Defendants expend considerable effort seeking to prove that Scharfenberger injured himself. We regard this issue as irrelevant because a prisoner‘s custodians cannot lawfully deny him adequate medical care even in instances of deliberate self injury.”
Although Scharfenberger concerned the adequacy of treatment after the prisoner‘s arm began swelling rather than the propriety of injecting the substance into the inmate, subsequent courts have followed Scharfenberger to hold that liability under
Our own Court has not specifically addressed the question whether the Eighth Amendment in some instances protects prisoners who may harm themselves. In the closest case on point, Wright v. Wagner, 5 Cir.1981, 641 F.2d 239, the plaintiffs argued, after an inmate‘s suicide, that an alleged failure to comply with
C. Assessing a Section 1983 Claim for Failure to Protect Against Self-Injury
A prisoner‘s or detainee‘s right under the Eighth Amendment to be protected from himself is not unlimited. The “deliberate indifference” standard is met only if there is a strong likelihood, rather than a mere possibility, that injury will occur.
First, a plaintiff must prove that deliberate indifference exists.
A plaintiff might also show deliberate indifference by revealing a pattern of medical neglect. Although a delay or denial of medical care may be mere negligence, and thus not actionable under
The evaluation of medical care for inmates, however, is an area of special deference from the courts, for it is related to both prison administration and medical judgment, two areas where the courts have acknowledged their limited expertise. Procunier v. Martinez, 1974, 416 U.S. 396, 94 S.Ct. 1800, 40 L.Ed.2d 224; cf. Woodbury v. McKinnon, 5 Cir.1971, 447 F.2d 839. Mere negligence, neglect, or medical malpractice is insufficient to state a claim for an Estelle violation. Fielder v. Bosshard, 5 Cir.1979, 590 F.2d 105. As this Court has recently held: “The Constitution does not command that inmates be given the kind of medical attention that judges would wish to have for themselves, nor the therapy that Medicare and Medicaid provide for the aged or the needy. It prohibits only ‘deliberate indifference to serious medical needs‘.” Ruiz v. Estelle, 5 Cir.1982, 679 F.2d 1115, 1149, cert. denied, 1983, 460 U.S. 1042, 103 S.Ct. 1438, 75 L.Ed.2d 795.
D. Review of the Pleadings
Having established the standard to which the defendants must be held under Estelle, we return to the pleadings. The claim against Officer Morris, who transported Partridge to the jail, was properly dismissed under
The pleadings against the remaining defendants present a different situation. The plaintiff alleged that the Houston Police had notice of Partridge‘s suicidal tendencies because of his aberrant behavior during his arrest and transport to the station, because of the warning in his wallet that he was under psychiatric care, because his father had informed the arresting officer that his son had suffered a nervous breakdown, and because the jail‘s records indicated that Partridge had attempted suicide during a detention just a few months before.
One means of establishing an Estelle claim is to prove state inaction in the face of a strong likelihood that harm will occur. Taken together, the allegations in the pleadings state a “strong likelihood” of harm sufficient to survive a motion to dismiss under
Whether the defendants’ failure to consult their medical records or to exercise special care in detaining Partridge given his aberrant behavior and the warnings constitute deliberate indifference are questions upon which we express no opinion. If
E. GRADY JOLLY, Circuit Judge, dissenting:
I.
I have serious doubts about the method of analysis of the majority opinion, serious concern about its practicality and impact for prison officials, and disbelief at its conclusion from the facts pled. I do agree, however, that the procedural posture of this case is correctly characterized by the majority as an appeal from the grant of a motion to dismiss for failure to state a claim upon which relief may be granted under
There may be some very few cases in which the eighth amendment affords a prisoner protection from his own hand under Estelle v. Gamble; however, even assuming that Estelle v. Gamble governs the present case, the majority‘s application of Estelle v. Gamble is untenable. The majority states that State Bank v. Camic correctly interpreted Estelle v. Gamble‘s “deliberate indifference” standard as applied to cases involving prisoner suicides. State Bank held that the “deliberate indifference” standard is met only where there is a “strong likelihood, not a mere possibility” that the prisoner would kill himself. State Bank at 1146. That does not mean a simple likelihood; what is required is a strong likelihood: suicide must be much more likely than not to occur. Thus, to state a claim, the complaint must, at a minimum, allow the plaintiffs to prove facts which would demonstrate that the City of Houston is chargeable with knowledge that Michael Partridge was much more likely to kill himself than not to kill himself. For the reasons detailed below, the complaint in this case is inadequate under State Bank and Estelle v. Gamble; I would dismiss it.
The facts set forth in the complaint which indicate the nature of Michael‘s condition are insufficient to state a claim for “deliberate indifference.” “The complaint must allege enough facts of prior psychiatric illness or treatment, of expert medical opinion, or behavior clearly evincing” the psychiatric need in question—here, constant monitoring and protection. Woodall v. Foti, 648 F.2d 268 (5th Cir.1981) (emphasis added). The information which the complaint alleges should have been available to jail personnel is first, that Michael‘s father told the arresting officers that Michael had previously had a “nervous breakdown” and that his son had a “medical alert” bracelet to that effect; second, that the jail clinic records indicated Michael had previously attempted suicide in prison; and, third, that Michael kicked the squad car doors and windows, and banged his head on its plastic divider, but calmed down when the officers spoke to him.
None of the facts alleged clearly evinces that it was strongly likely that Michael was about to kill himself. Michael‘s “medical alert” bracelets carried only the inscriptions “Medical Alert—See Card” and “Heart Patient.” The jail personnel noted that Michael wore these bracelets, the complaint says. The “card” was actually a letter, which is attached to the complaint, stating that Michael was under the care of a psychologist for a “mild” organic brain syndrome for which he took Valium. That Michael took Valium in no way indicates a potential for suicide; Valium is one of the most widely prescribed drugs in the country; millions of people take it every day for mild anxiety and other psychological problems. Neither can the fact that Michael had previous psychological problems nor
Even a prison clinic record of an inmate‘s attempted suicide does not clearly evince that a prisoner is a very likely suicide, as this court has noted in the past:
Petitioner ... cut his wrist in four or five places with a razor blade .... It is stretching the evidence to call this “wrist slashing” a suicide attempt .... Some defendants, facing an almost certain conviction and a long sentence, resort to cutting their arms and wrist. See United States v. Bentvena .... In their minds, it can help them get a continuance or bolster their plea of insanity .... [Petitioner] was ... a callous role player who would mutilate himself to manipulate his environment. However, even if petitioner made an actual attempt to kill himself on the occasion in question, that alone would not support a finding of lack of mental capacity, for the mere fact of suicide, standing alone, does not prove mental illness or incapacity.
Stepp v. Estelle, 524 F.2d 447, 454 (5th Cir.1975) (Wisdom, J. joining the court‘s opinion).
In United States v. Bentvena, 319 F.2d 916 (2d Cir.1963), one of the defendants, while in pre-trial detention, hanged himself in his cell, but was unharmed. The next day he slashed his wrists in the shower. The court observed that the defendant‘s acts were designed to delay the trial and to manipulate the court and prison officials and accordingly held that the defendant had waived his sixth amendment rights when the trial court refused to delay the trial, forcing the defendant to appear without counsel. Bentvena at 930, 936. Bentvena illustrates that there is simply no way the jail personnel could have known of the seriousness of Michael‘s condition even if they had had access to the clinic report.
II.
The degree to which the majority opinion departs from accepted principles is indicated by its strained use of precedent. Although the majority cites Wright v. Wagner, that case stands firmly against the contention that the present complaint states a claim. In Wright the prisoner had attempted to commit suicide by hanging himself soon after his arrest, but failed. Later the same day he deliberately banged his head against the wall of his cell and told a prison matron that he had done so intentionally and had no regard for his physical well-being. Two days later he was found dead from a brain hemorrhage in his cell. Although the prison had failed to take the effective suicide prevention measures urged by the plaintiffs, the district court found the prison not liable under Estelle v. Gamble or even under the associated state wrongful death claim. This court affirmed, finding that the prison‘s
Similarly, Estelle v. Gamble itself rebuffs the majority‘s positions. Gamble complained repeatedly to prison authorities of severe pains in his chest, arms and legs and of “blank outs” for days after he unloaded a truck. He was not only denied treatment but was subjected to discipline for “shirking” his work. In Estelle v. Gamble the prison could have treated Gamble at almost negligible cost and relieved the severe pain which he continually brought to their attention in the face of disciplinary action. Even on these facts and despite the fact that Gamble filed his complaint pro se, he was held not to have stated a claim upon which relief could be granted, Gamble v. Estelle, 554 F.2d 653 (5th Cir.1977) (on remand), and yet, no allegations even comparable to the rejected allegations of Estelle v. Gamble have been made in the present case.
The majority‘s other use of precedent is equally questionable. That Woodall v. Foti supports dismissal of this claim has been touched on above. The majority‘s effort to find support in Scharfenberger v. Wingo is also strained. Scharfenberger held that a prison is required to supply medical care to prisoners requesting it even for self-inflicted wounds. Scharfenberger says nothing about a prison‘s obligation to prevent a prisoner from harming himself; accordingly, that case is simply inapposite. The majority‘s use of district court cases from Ohio and Connecticut, Matje and Guglielmoni, is also unpersuasive; those cases are of little authority and neither contains a considered discussion of the present issue.
III.
Because this complaint fails to allege facts amounting to the required “deliberate indifference” standard, it should be dismissed. Estelle v. Gamble expressed its “deliberate indifference” standard as a special case of the “wanton infliction of pain” standard of Gregg v. Georgia, 428 U.S. 153, 96 S.Ct. 2909, 49 L.Ed.2d 859 (1976). “[D]eliberate indifference to serious medical needs of prisoners constitutes the ‘unnecessary and wanton’ infliction of pain” prohibited by Gregg. Estelle v. Gamble at 291. Thus, “deliberate indifference” requires wanton, not merely negligent, behavior for liability to accrue. “Wanton” behavior has uniformly been interpreted as more egregious than even gross negligence. Prosser, Law of Torts, 4th Ed. at 184. No such behavior is alleged here. Certainly the defendant‘s failure to take the expensive steps alleged by the plaintiff as required to avoid an eighth amendment violation (acquiring many more guards, expensive T.V. monitors, special psychiatric training for jail personnel, etc.) cannot be wanton behavior. Neither does anything else alleged here potentially amount to wantonness.
Far from making out a claim of deliberate indifference, the complaint states at most a claim of marginal negligence, as is made clear by White v. United States, 4th Cir.1963, 317 F.2d 13, on remand, D.Va. 1965, 244 F.Supp. 127, aff‘d, 4th Cir.1966, 359 F.2d 989. In White, Meeks was an inmate in a Veterans Administration psychiatric hospital. Before entering the hospital, he had attempted to commit suicide four times, of which the hospital had records. Meeks complained to the hospital personnel that he was again becoming suicidal and asked to be tied down to his bed. Dr. Parks, the staff physician in charge of Meeks’ ward, refused Meeks’ requests for restraint. Parks admitted that he was not familiar with Meeks’ prior attempts at suicide nor with the fact that Meeks had asked to be restrained for similar reasons some months before. Meeks, as Parks knew, was on Thorazine, a tranquilizer. Meeks continued to complain to Dr. Crowgey, who also had not been apprised of Meeks’ prior attempts to commit suicide and who also refused to restrain Meeks.
I repeat myself to say yet again that the complaint in the present case makes out at most a claim for negligence. It is clear that the Veterans Hospital in White was given at least as much notice as the Houston jail in this case. In addition, the hospital was expressly designed to screen and treat mentally ill patients. We deal here with lay persons, policemen and jailers, not doctors. Yet, the hospital was held not to have been even simply negligent in failing to take suicide prevention precautions with respect to Meeks. Perhaps White may be considered a close negligence case, but the standard of care in the present case is wantonness. Where a complaint makes out at most a marginal claim for negligence, it cannot be said that it states a claim for “deliberate indifference” under Estelle v. Gamble.1
IV.
Because a thorough analysis of the important considerations in this case reveals substantial differences between suicide and ordinary medical problems, I specifically dissent from the majority‘s refusal to acknowledge the distinctions between the right to suicide prevention and the right to ordinary medical care under Estelle v. Gamble.
Estelle v. Gamble does not require that we equate cases involving a heightened potential for harassment and abuse with cases of physical or mental illness not so susceptible to prisoner manipulation. The Partridges’ suit against the individual defendants here points out the potential for abuse in the majority opinion. Under the majority‘s ruling the prisoner who “attempted suicide” twice in Bentvena would have been able to make the prison officials defend a section 1983 action for his self-inflicted damages sustained in his second “suicide attempt.” The majority‘s position would have permitted the plaintiff there to state a claim by alleging that his first “attempt” put the prison and its officials on notice that he might make a second “attempt” on his own life just as Michael‘s behavior and record in this case has been held to permit the claims against the Houston Chiefs of Police, B.K. Johnson and Lee Brown, the Chief of the Jail Division, K.L. McBurnett, and his predecessor to go to trial.2 The fact that the officials and the prison in Bentvena might have defended themselves from such a suit with psychiatric testimony that the “attempts” were not serious attempts would not have spared the officials there from the harassment of a contrived and manipulative suit. While contrived suits concerning physical illness are not impossible, the potential for abuse in cases involving suicide is clearly greater.
In addition, we should be restrained in applying Estelle v. Gamble here to limit the discretion of prison authorities, because even genuine suicidal desires are not per se a medical condition. It is certainly true that suicidal desires may coincide with mental illness, but “the mere fact of suicide, standing alone, does not prove mental illness ....” Stepp at 454. In many cases suicide will not indicate a psychiatric problem. Our approach should recognize that the issue in those cases is to what extent a prison is required to prevent a prisoner from inflicting pain on himself independently of any mental health considerations.
That it is unwise to classify suicidal attempts with other possible symptoms of mental illness is evidenced, especially in this Texas jail case, by their severance under Texas law. Texas law provides for continuous observation and eventual commitment to medical facilities of a wide class of mentally ill prisoners.
V.
The majority believes that their decision is a consequence of what they term the eighth amendment reaching some acts of “deliberate self injury.” I take exception if by “deliberate self injury” the majority means to include the self-injury that is not a product of mental illness. Where the state has no actual knowledge of a prisoner‘s considered decision to take his own life, there can be no “state action” causing the suicide under the fourteenth amendment unless that term is to be drained of coherent meaning. In such circumstances suicide is no more a medical problem than homicide is a medical problem in the absence of mental illness. Where the prisoner is cogent and the state unknowing, it is not possible to argue seriously that there has been state action through any official aid or encouragement.3 Moose Lodge Number 107 v. Irvis, 407 U.S. 163, 92 S.Ct. 1965, 32 L.Ed.2d 627 (1972). The mere fact that the prisoner is subject to state control does not render his own act state action.
VI.
My considerations of the method of analysis, the use of precedent and the practical consequences of the majority opinion dis-
It is State Bank‘s approach, as well as its standard and holding, which is important here; by focusing on precedent involving prisoner attacks, the Seventh Circuit avoids the conceptual confusion in equating suicide cases with cases involving the need for ordinary medical care. The present majority acknowledges the importance of State Bank only in form, but departs from the substantive reasoning underlying that case. I believe that it is important that we avoid the conceptual confusion present in the majority opinion from which State Bank wisely drew back. In sum, I would treat this case essentially as I would treat a prisoner assault case and because no facts are alleged which remotely imply “an official intent to inflict unwarranted harm,” I would affirm the dismissal of the complaint.
VII.
In conclusion, because the complaint in this case fails to state a claim under Estelle v. Gamble, because the majority fails to perceive the subtle but very serious differences between the right to suicide protection and right to ordinary medical care, and departs from established precedent, I respectfully dissent.