[PUBLISH]
IN THE UNITED STATES COURT OF APPEALS
FOR THE ELEVENTH CIRCUIT FILED ________________________ U.S. COURT OF APPEALS ELEVENTH CIRCUIT NOVEMBER 16, 2010 No. 09-15113 JOHN LEY ________________________ CLERK
D. C. Docket No. 07-00629-CV-J-25-MCR
JOHN EUGENE YOUMANS,
Plaintiff-Appellee,
versus
T. A. GAGNON, #5715, in his official and individual capacity,
Defendant-Appellant.
________________________
Appeal from the United States District Court for the Middle District of Florida _________________________
(November 16, 2010) Before EDMONDSON, HILL and ALARCÓN,* Circuit Judges.
PER CURIAM:
This case is about the defense of qualified immunity in situations involving
delay in medical care for a pretrial detainee.
Plaintiff-Appellee, a pretrial detainee at the time of these events, was beaten
(an occurrence in which Defendant-Appellant took no part) in connection with
Plaintiff’s arrest on robbery charges. He alleges that later Defendant, by booking
and questioning Plaintiff before seeking medical care for his injuries, was
deliberately indifferent to Plaintiff’s serious medical need in violation of
Fourteenth Amendment rights. He brought suit against Defendant in Defendant’s
individual capacity; Defendant moved for summary judgment on qualified
immunity grounds. The District Court denied the motion; Defendant now appeals.
We reverse the District Court’s decision and conclude that Defendant is entitled to
immunity from this suit.
* Honorable Arthur L. Alarcón, United States Circuit Judge for the Ninth Circuit, sitting by designation.
2 I. BACKGROUND
We view the facts in the light most favorable to Plaintiff.1 See Andujar v.
Rodriguez, 486 F.3d 1199, 1202 (11th Cir. 2007). In June 2007, two law
enforcement officers attempted to stop Plaintiff John E. Youmans on suspicion of
robbery as he drove away from the scene of the crime. After Plaintiff briefly
pulled over, he drove away. The officers gave chase in their cars, and Plaintiff
pulled over again after about seven minutes; the officers arrested Plaintiff.
Incident to Plaintiff’s arrest, the officers beat him: Plaintiff alleges that one officer
ripped his shirt, leaving portions of his torso exposed, and then pulled him from his
truck by his hair. With Plaintiff’s feet still in the truck and his torso on the ground,
he was kicked and punched. As a result, Plaintiff had visible abrasions on his
head, face, shoulder, elbow, and hand.
The arresting officers took Plaintiff to the police station for booking, where
Defendant Timothy Gagnon met and interviewed Plaintiff and did some booking
paperwork. The interview is recorded on video complete with sound, including the
time Plaintiff was alone in the interview room while Defendant was out. Plaintiff
confessed to the robbery but gave a false name and birth date. Defendant spent
1 For this appeal, we assume these facts. We do not decide today that these assumed facts are entirely consistent with reality.
3 approximately thirty minutes learning Plaintiff’s true identity. At the end of the
booking process, officers handcuffed Plaintiff to take him to the detention facility;
but then Plaintiff requested to speak to Defendant again. Plaintiff then spent about
seven more minutes in animated discussion with Defendant, attempting to
implicate Plaintiff’s passenger in the robbery. Then Plaintiff was transmitted to a
detention facility.
Roughly four hours passed between the time that officers arrested and beat
Plaintiff and the time that he received medical care; almost three of those hours
were spent in Defendant’s custody.2 During this three-hour time, Plaintiff never
specifically requested medical treatment. But Plaintiff groaned, exclaimed “ouch”
and “ow,” and appeared to be disoriented at times; he told Defendant that he
thought the officers had “cracked something” in his hand and indicated once to
Defendant that his vision was blurred.3 Plaintiff had several cuts and abrasions on
his head, face, shoulder, elbow, and hand; some blood was visible on Plaintiff.
2 The record indicates that officers arrested Plaintiff at approximately 1:03 p.m.; he arrived at the station around 2:15 p.m.; and the jail nurse saw him at 5:17 p.m. 3 Plaintiff spoke to himself at times when Defendant was outside of the room. Much of this speech is unintelligible to us even when Plaintiff’s counsel has suggested what Plaintiff is saying. For example, Plaintiff’s brief says Plaintiff—while Defendant was outside the room—indicated that he thought he had a broken shoulder. (Defendant acknowledged that he looked at the video monitors in real time when he was outside the interview room). Plaintiff’s support for this claim is a citation to a point in the video, but the video does not support this claim: there are just unintelligible utterances. No reasonable jury could find that Plaintiff indicated to Defendant (through the video) that Plaintiff had a broken shoulder. See Scott v. Harris, 127 S. Ct. 1769, 1776 (2007).
4 Despite the injuries, Plaintiff had sufficient use of his hands to sign an
acknowledgment of his rights and to open and drink a can of lemonade; while
Defendant was away, Plaintiff also attempted to use the top of the can to unscrew a
panel covering the interview room’s video camera.
Upon arriving at the detention facility from the police station, the nurse at
the detention facility sent Plaintiff to the hospital. At the hospital, attending
physicians diagnosed him with injuries consistent with blunt trauma: multiple
contusions.4 Plaintiff underwent MRIs, a CT scan, and x-rays. Physicians
prescribed Motrin and Skelaxin (a muscle relaxant) and referred him to a trauma
clinic for follow-up care. Plaintiff has drawn our attention to nothing in the record
about any follow-ups.
Plaintiff filed suit against Defendant, alleging deliberate indifference to a
serious medical need in violation of Plaintiff’s Fourteenth Amendment rights.5
Defendant moved for summary judgment on qualified immunity grounds. The
District Court denied the motion. Defendant then filed this interlocutory appeal.
4 The record indicates that Plaintiff vomited after arriving at the hospital and that he self- described his pain-intensity level as ten out of ten. Defendant had no knowledge of these facts while Plaintiff was in Defendant’s custody. 5 Plaintiff also filed suit against the arresting officers in their personal capacities for use of excessive force; the arresting officers are not parties to this appeal.
5 II. DISCUSSION
A. Qualified Immunity
We have jurisdiction over Defendant’s interlocutory appeal under 28 U.S.C.
§ 1291 and the collateral order doctrine. See Bryant v. Jones, 575 F.3d 1281, 1288
n.2 (11th Cir. 2009). We “review de novo a district court’s denial of a motion for
summary judgment on qualified immunity grounds.” Andujar, 486 F.3d at 1202.
The purpose of the qualified immunity defense is to “protect[] government
officials ‘from liability for civil damages insofar as their conduct does not violate
clearly established statutory or constitutional rights of which a reasonable person
would have known.’” Pearson v. Callahan, 129 S. Ct. 808, 815 (2009) (quoting
Harlow v. Fitzgerald, 102 S. Ct. 2727, 2738 (1982)). The defense “ensure[s] that
before they are subjected to suit, officers are on notice their conduct is unlawful.”
Saucier v. Katz, 121 S. Ct. 2151, 2158 (2001). “Unless a government agent’s act is
so obviously wrong, in the light of pre-existing law, that only a plainly
incompetent officer or one who was knowingly violating the law would have done
such a thing, the government actor has immunity from suit.” Lassiter v. Ala. A&M
Univ., Bd. of Trs., 28 F.3d 1146, 1149 (11th Cir. 1994) (en banc).
6 Assessing a claim of qualified immunity involves a two-step process: once a
defendant raises the defense, the plaintiff bears the burden of establishing both that
the defendant committed a constitutional violation and that the law governing the
circumstances was already clearly established at the time of the violation. Pearson,
129 S. Ct. at 815-16. Following the Supreme Court’s decision in Pearson, we are
free to consider these elements in either sequence and to decide the case on the
basis of either element that is not demonstrated. Id. at 818. In the present case, it
seems best to proceed directly to the question of whether the applicable law was
already clearly established when the incident took place.
B. “Clearly Established” Law
Whether or not Defendant’s conduct constituted deliberate indifference to a
serious medical need in violation of Plaintiff’s Fourteenth Amendment rights,6 the
law applicable to these circumstances was not already clearly established at the
time of the alleged violation. A judicial precedent with materially identical facts is
not essential for the law to be clearly established, but the preexisting law must
6 The Fourteenth Amendment governs claims of medical indifference to the needs of pretrial detainees while the Eighth Amendment applies to claims of convicted prisoners. Andujar, 486 F.3d at 1202 n.3. Because the minimum standard for providing medical care to pretrial detainees is the same as the standard for providing medical care to convicted prisoners under the Eighth Amendment, see id., we consider as precedents cases decided under either amendment.
7 make it obvious that the defendant’s acts violated the plaintiff’s rights in the
specific set of circumstances at issue.7 See Evans v. Stephens, 407 F.3d 1272,
1282 (11th Cir. 2005) (en banc).
In deciding about qualified immunity, we are considering what an
objectively reasonable official must have known at the pertinent time and place;
that is, we are examining “‘whether it would be clear to a reasonable officer that
his conduct was unlawful in the situation [the defendant officer] confronted.’”
Brosseau v. Haugen, 125 S. Ct. 596, 599 (2004) (emphasis added) (quoting
Saucier, 121 S. Ct. at 2156); see also Pace v. Capobianco, 283 F.3d 1275, 1282
(11th Cir. 2002). “This inquiry, it is vital to note, must be undertaken in light of the
specific context of the case, not as a broad general proposition . . . .” Saucier, 121
S. Ct. at 2156.
The Supreme Court has warned against allowing plaintiffs to convert the
rule of qualified immunity into “a rule of virtually unqualified liability simply by
alleging violation of extremely abstract rights.” Anderson v. Creighton, 107 S. Ct.
3034, 3038-39 (1987). More than a general legal proposition—for example, to act
7 Very occasionally, qualified immunity can be denied where the plaintiff establishes that the defendant’s conduct so obviously violated federal law that the defendant must have known the acts violated federal law even in the absence of preexisting caselaw addressing materially similar facts. See, e.g., Priester v. City of Riviera Beach, Fla., 208 F.3d 919, 926-27 (11th Cir. 2000).
8 reasonably—is usually required; if a plaintiff relies on a general rule, it must be
obvious that the general rule applies to the specific situation in question. See
Brosseau, 125 S. Ct. at 599 (noting that general tests may be sufficient to establish
law clearly in “an obvious case”). Minor variations between cases may prove
critical. See Marsh v. Butler Cnty, Ala., 268 F.3d 1014, 1032 (11th Cir. 2001) (en
banc).
Thus, evaluating the “objective legal reasonableness” of an officer’s acts
requires examining whether the right at issue was clearly established in a
“particularized” and “relevant” way. Anderson, 107 S. Ct. at 3039. The
unlawfulness of a given act must be made truly obvious, rather than simply
implied, by the preexisting law. See id.
With this understanding about the necessity of clear law being tied to the
specific factual context, we turn to the issue in this case. To prevail on a claim of
deliberate indifference to serious medical need in violation of the Fourteenth
Amendment, a plaintiff must show: “(1) a serious medical need; (2) the
defendant[’s] deliberate indifference to that need; and (3) causation between that
indifference and the plaintiff’s injury.” Mann v. Taser Int’l, Inc., 588 F.3d 1291,
1306-07 (11th Cir. 2009).
“A serious medical need is ‘one that has been diagnosed by a physician as
9 mandating treatment or one that is so obvious that even a lay person would easily
recognize the necessity for a doctor’s attention.’” Id. at 1307 (quoting Hill v.
Dekalb Reg’l Youth Det. Ctr., 40 F.3d 1176, 1187 (11th Cir. 1994)).8 In general,
serious medical needs are those “requiring immediate medical attention.” See Hill,
40 F.3d at 1190.
To prove “deliberate indifference” to a serious medical need, a plaintiff must
show “‘(1) subjective knowledge of a risk of serious harm; (2) disregard of that
risk; (3) by conduct that is more than [gross] negligence.’” Townsend v. Jefferson
Cnty., 601 F.3d 1152, 1158 (11th Cir. 2010) (quoting Bozeman v. Orum, 422 F.3d
1265, 1272 (11th Cir. 2005)). We conclude that neither the “serious medical need”
nor the “deliberate indifference” element was established with such clarity in June
2007 that an objectively reasonable police officer in Defendant’s place would have
been on advance notice that Defendant’s acts in this case would certainly violate
the Constitution.
The best response to a serious medical need is not required by federal law in
these cases. Judicial decisions addressing deliberate indifference to a serious
8 Serious medical need might alternatively be established where the condition worsens due to a delay. See Mann, 588 F.3d at 1307. Here, because Plaintiff does not contend further injury from the delay in treatment, the proper test is whether a lay person would easily recognize the need as serious. In addition, that a medical need might be recognizable by a trained medical professional, such as a nurse, is not enough. Instead, the need for immediate medical assistance must have been apparent to the untrained eye of a layperson. See id. at 1307-08.
10 medical need, like decisions in the Fourth Amendment search-and-seizure realm,
are very fact specific. At a high level of generality, certain aspects of the law have
been established: lengthy delays are often inexcusable, see Harris v. Coweta Cnty.,
21 F.3d 388, 394 (11th Cir. 1994) (stating delay of several weeks in treating
painful and worsening hand condition was deliberate indifference); shorter delays
may also constitute a constitutional violation if injuries are sufficiently serious, see
Bozeman, 422 F.3d at 1273 (delaying medical treatment for fourteen minutes was
deliberate indifference where the plaintiff was not breathing during that time); and
the reason for the delay must weigh in the inquiry, see id. But specific cases of
deliberate indifference are complicated: the threshold of deliberate indifference is
connected to combinations of diverse interdependent factual elements. And for the
present case, it was not already clearly established as a matter of law in June 2007
that a four-hour delay for injuries of this kind violated the Fourteenth Amendment.
In fact, earlier cases considering injuries of similar consequence concluded
that delays of roughly comparable length were acceptable for constitutional
purposes.9 For instance, in Andujar, a dog bit the plaintiff as he fled from police in
1999, leaving puncture wounds in the front and back of his thigh that impaired his
9 While material differences exist between the facts of the present case and the facts of earlier cases cited here, the earlier cases are sufficiently similar to help to render the law applicable to the circumstances of this case unclear to an objectively reasonable officer.
11 ability to walk. 486 F.3d at 1201-03. The defendant paramedics applied a
temporary bandage to stop the bleeding long enough for the plaintiff to be booked
at the police station, but the plaintiff did not receive the stitches he needed until
two hours after the bite. Id. at 1203-04. In that case, we concluded that the
plaintiff’s medical condition was not urgent and that the “short delay” of two hours
was permissible to allow the police sufficient time to book the plaintiff. Id. at
1204.
In Hill, we concluded that a delay of four hours in seeking treatment for
stomach pain, vomiting blood, and blood in the plaintiff’s underwear did not
constitute deliberate indifference where the delay was due to the official’s need to
finish feeding the rest of the inmates. 40 F.3d at 1190-92.
In addition, this Circuit -- before 2007 and with seeming agreement -- had
cited other Circuits’ cases that say that longer delays for similar injuries did not
constitute deliberate indifference to a serious medical need.10 When decisional law
10 See, e.g., Kane v. Hargis, 987 F.2d 1005, 1008-09 (4th Cir. 1993) (cited in Hill, 40 F.3d at 1190) (concluding that a four-hour delay in seeking medical treatment for “cracked teeth, a cut nose, and a bruised face” was not a constitutional violation where there was “no indication these injuries required immediate medical treatment”); Gaudreault v. Salem, 923 F.2d 203, 207- 08 (1st Cir. 1990) (cited in Hill, 40 F.3d at 1188 n.24) (concluding that a ten-hour delay in providing treatment for “multiple bruises[] to the forehead, left and right orbits of his eyes, nasal area, left ribs, right flank and left shoulder, . . . a corneal abrasion and an abrasion on the upper back” and “‘massive swelling’ in the head” did not constitute deliberate indifference); Martin v. Gentile, 849 F.2d 863, 871 (4th Cir. 1988) (cited in Hill, 40 F.3d at 1188 n.22) (concluding that a fourteen-hour delay in treatment for cuts, bruises, and a quarter-inch piece of glass embedded in the palm did not constitute deliberate indifference).
12 is required for prior notice, the law can be clearly established by decisions of the
U.S. Supreme Court, Eleventh Circuit, or the highest court of the state where the
case arose. See Jenkins ex rel. Hall v. Talladega City Bd. of Educ., 115 F.3d 821,
826 n.4 (11th Cir. 1997). But in the absence of controlling precedent, cases
decided outside this Circuit can buttress our view that the applicable law was not
already clearly established. We must not hold police officers to a higher standard
of legal knowledge than that displayed by the federal courts in reasonable and
reasoned decisions; where “judges thus disagree on a constitutional question, it is
unfair to subject police to money damages for picking the losing side of the
controversy.” Wilson v. Layne, 119 S. Ct. 1692, 1701 (1999); see also Barts v.
Joyner, 865 F.2d 1187, 1193 (11th Cir. 1989) (“We cannot realistically expect that
reasonable police officers know more than reasonable judges about the law.”). For
background, see Marsh, 268 F.3d at 1039-40. In the present case, that this Court
had cited cases of longer delays for similar injuries further confirms for us that an
objectively reasonable police officer in Defendant’s place would not have known
that Defendant’s conduct would violate Plaintiff’s constitutional rights.
Cases cited by Plaintiff are too different from this case to make the law
applicable to the circumstances of this case clearly established in June 2007. For
example, Plaintiff cites Aldridge v. Montgomery, 753 F.2d 970 (11th Cir. 1985),
13 where we denied qualified immunity to a defendant who delayed treatment of a
serious bleeding cut for approximately two and a half hours. 753 F.2d at 972-73.
Critical to our decision in that case was that the plaintiff’s cut bled continuously
during that time, causing blood to pool on the plaintiff’s clothing and the floor; and
the cut ultimately required six stitches. Id.
Nothing in the record in the present case shows that Plaintiff’s cuts bled
while in Defendant’s custody; he ultimately did not require stitches. Significant,
sustained bleeding requiring later stitches is a far greater indicator of a need for
urgent medical care than the mere presence of cuts and bruises as in the present
case.11 See Hill, 40 F.3d at 1189 (“[Plaintiff] has not contended that there was
continued bleeding that would signify an urgent or emergency situation. . . .”).
This factual variance is the kind of variation between cases that makes a critical
difference in determining whether the applicable law was already clearly
established at the time the occurrence underlying this case arose. We cannot say
11 Also, we note that the delay in Aldridge was due to officers “waiting for a detective to tell them what to do.” 753 F.2d at 972. This reason for delay differs from the facts of this case, where the delay occurred due to the need to interview and to book Plaintiff. Earlier cases establish that the reason for a delay matters: a good reason may justify a delay. See, e.g., Andujar, 486 F.3d at 1204 (stating that a delay to book the plaintiff was reasonable). In the present case, that the delay in treatment extended no longer than the time to interview and book Plaintiff is undisputed; and Plaintiff does not contend that the period for interviewing and booking was, in itself, excessive. The delay was also extended by Plaintiff’s acts of giving a false name and then attempting to implicate his passenger. Under earlier cases, a reasonable law enforcement officer could consider getting Plaintiff properly identified and determining if he acted alone to be valid reasons justifying some delay in treatment, given the injuries seemingly involved here.
14 that Aldridge would provide an objective police officer with adequate advance
notice that the conduct at issue in this case would violate Plaintiff’s constitutional
rights.
III. CONCLUSION
We conclude that it is not -- and most important, was not in June 2007 --
clear from the preexisting law that all objectively reasonable policemen would
have known that a four-hour delay for booking and interviewing a person with
injuries of the kind asserted here is a constitutional violation.12 In reaching this
conclusion, we stress that “[g]overnment officials are not required to err on the side
of caution.” Marsh, 268 F.3d at 1030 n.8. The District Court erred in deciding that
Defendant was not entitled to the defense of qualified immunity.
REVERSED and REMANDED.
12 We also note that Plaintiff did not request medical care. A person is not required to request medical care to prevail on a claim of deliberate indifference to a serious medical need. But in this situation, where Plaintiff engaged in conversation on different topics, Plaintiff’s failure to request medical care supports our determination that objectively reasonable law enforcement officers -- held to the standard of a layperson, rather than a trained medical professional -- would not be on notice that Plaintiff needed immediate medical care.