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Policy of Hiring Trained Medical Professionals Does Not Immunize County from Municipal Liability in Wrongful Jail Death; Case Settles for $475,000.00
by John E. Dannenberg
The Ninth Circuit U.S. Court of Appeals held that where a Los Angeles County Jail prisoner died of allegedly deficient medical attention, the county?s defense of relying upon the professional discretion of medical doctors to automatically immunize the county from municipal ?policy? liability in a subsequent wrongful death action did not trump plaintiff?s liability claims based upon failure to properly train staff and set treatment policies.
John Idlet, 71 years old and weighing 350 pounds, began a 120-day jail sentence on March 11, 2002. Because he had been under continuous doctor?s care for congestive heart failure since 1998, his attorney obtained a sentencing-court order requiring county jail medical staff to examine him and report back to the court. On March 12, a jail doctor ordered Idlet transferred to the jail?s Medical Service?s Bureau (MSB) care section, staffed with doctors from 6AM to 6PM, Monday to Friday. The MSB did not have cardiac monitors. Nurses were instructed to monitor him and notify a doctor as needed.
On ?admission,? there was no bed for Idlet and he spent 38 hours in a wheelchair, during which time he did not receive his medications. On March 15, a nurse reported Idlet had 3+ (severe) ankle swelling (edema). On March 18 the nurse reported Idlet?s shortness of breath and a pulse of 100, but did not call a doctor. On March 21, Idlet asked for a doctor because his abdomen and legs were swollen. No doctor saw him that day. On March 22 Dr. Wallace increased Idlet?s Lasix (diuretic) dosage, although Idlet was not seen by Wallace. On March 25, Idlet?s medications were inexplicably withheld. On March 26 he was coughing, had swollen legs and a pulse of 115. Dr. Wallace saw Idlet but did not note the increased heart rate. On March 28, Idlet fell and nurses later reported him ?very swollen.? Later that day nurses reported Idlet had ?low brown urine output? and crackles on his lung fields [indicating decompensated congestive heart failure], but no doctor was called. On March 29 he had diminished breath, moist coughing, shortness of breath, a severe decrease in oxygen saturation and low blood pressure. At 12:44 a.m., Dr. Johnson ordered Idlet taken to a hospital, where he suffered cardiac arrest and died two hours later.
Suing Los Angeles County under 42 U.S.C. § 1983, Idlet?s surviving spouse, Philomene Long, began in state superior court. The county removed the case to federal court, where Long maintained both federal constitutional claims as well as state law-based claims. The U.S. District Court (C.D. Cal.) dismissed all of the federal claims, and the state law claims were dismissed without prejudice. Long appealed the dismissal of the federal claims.
The Ninth Circuit narrowed the case to the question of whether a county could evade municipal liability where the defendants claimed they did not exhibit overt ?deliberate indifference? ? that is, follow a municipal policy of willful intent or knowing disregard so as to harm the plaintiff. Long?s argument was couched in precedent holding that failure to train county actors could suffice to support a failure-to-treat claim. Here the question was, can a failure to adequately train justifiably be said to represent municipal ?policy? sufficient to trigger § 1983 liability?
First, the county argued that by hiring trained professionals, it insulated itself from municipal ?policy? liability. The court rejected this theory, relying on precedent in Miranda v. Clark County, 319 F.3d 465 (9th Cir. 2003) (en banc) [public defender not immune from ineffective counsel claim just because he was a bar lawyer] and Johnson v. Hawe, 388 F.3d 676 (9th Cir. 2004) [lack of police ?self-training? did not excuse liability from unconstitutional arrest]. As to a corollary question, the adequacy of staff training, the court found that on the evidence, there was at least a triable issue of fact as to whether the county?s policy of relying on professionals without training them on how to implement MSB procedures amounted to deliberate indifference.
Alternatively, the Ninth Circuit found that the county could be held liable for failure to implement policies regarding what to do if a patient suffered a fall, required transfer, or refused an essential medical treatment such as oxygen. The appeals court ruled that ?a county?s lack of affirmative policies or procedures to guide employees can amount to deliberate indifference, even when the county has other general policies in place,? but noted that this was the province of a jury to evaluate.
The appellate court concluded that since Long had presented ?sufficient probative evidence to create a triable issue regarding whether the county?s policies constituted deliberate indifference to [Idlet?s] constitutional rights which were the moving force behind his death,? it reversed and remanded the case for further proceedings. See: Long v. County of Los Angeles, 442 F.3d 1178 (9th Cir. 2006).
On February 27, 2007, on remand from the Ninth Circuit, the Los Angeles jail settled the case for $475,000.00. The county incurred attorney fees of $330,227.49 in defending the case. The settlement is available on the PLN website.
The Ninth Circuit U.S. Court of Appeals held that where a Los Angeles County Jail prisoner died of allegedly deficient medical attention, the county?s defense of relying upon the professional discretion of medical doctors to automatically immunize the county from municipal ?policy? liability in a subsequent wrongful death action did not trump plaintiff?s liability claims based upon failure to properly train staff and set treatment policies.
John Idlet, 71 years old and weighing 350 pounds, began a 120-day jail sentence on March 11, 2002. Because he had been under continuous doctor?s care for congestive heart failure since 1998, his attorney obtained a sentencing-court order requiring county jail medical staff to examine him and report back to the court. On March 12, a jail doctor ordered Idlet transferred to the jail?s Medical Service?s Bureau (MSB) care section, staffed with doctors from 6AM to 6PM, Monday to Friday. The MSB did not have cardiac monitors. Nurses were instructed to monitor him and notify a doctor as needed.
On ?admission,? there was no bed for Idlet and he spent 38 hours in a wheelchair, during which time he did not receive his medications. On March 15, a nurse reported Idlet had 3+ (severe) ankle swelling (edema). On March 18 the nurse reported Idlet?s shortness of breath and a pulse of 100, but did not call a doctor. On March 21, Idlet asked for a doctor because his abdomen and legs were swollen. No doctor saw him that day. On March 22 Dr. Wallace increased Idlet?s Lasix (diuretic) dosage, although Idlet was not seen by Wallace. On March 25, Idlet?s medications were inexplicably withheld. On March 26 he was coughing, had swollen legs and a pulse of 115. Dr. Wallace saw Idlet but did not note the increased heart rate. On March 28, Idlet fell and nurses later reported him ?very swollen.? Later that day nurses reported Idlet had ?low brown urine output? and crackles on his lung fields [indicating decompensated congestive heart failure], but no doctor was called. On March 29 he had diminished breath, moist coughing, shortness of breath, a severe decrease in oxygen saturation and low blood pressure. At 12:44 a.m., Dr. Johnson ordered Idlet taken to a hospital, where he suffered cardiac arrest and died two hours later.
Suing Los Angeles County under 42 U.S.C. § 1983, Idlet?s surviving spouse, Philomene Long, began in state superior court. The county removed the case to federal court, where Long maintained both federal constitutional claims as well as state law-based claims. The U.S. District Court (C.D. Cal.) dismissed all of the federal claims, and the state law claims were dismissed without prejudice. Long appealed the dismissal of the federal claims.
The Ninth Circuit narrowed the case to the question of whether a county could evade municipal liability where the defendants claimed they did not exhibit overt ?deliberate indifference? ? that is, follow a municipal policy of willful intent or knowing disregard so as to harm the plaintiff. Long?s argument was couched in precedent holding that failure to train county actors could suffice to support a failure-to-treat claim. Here the question was, can a failure to adequately train justifiably be said to represent municipal ?policy? sufficient to trigger § 1983 liability?
First, the county argued that by hiring trained professionals, it insulated itself from municipal ?policy? liability. The court rejected this theory, relying on precedent in Miranda v. Clark County, 319 F.3d 465 (9th Cir. 2003) (en banc) [public defender not immune from ineffective counsel claim just because he was a bar lawyer] and Johnson v. Hawe, 388 F.3d 676 (9th Cir. 2004) [lack of police ?self-training? did not excuse liability from unconstitutional arrest]. As to a corollary question, the adequacy of staff training, the court found that on the evidence, there was at least a triable issue of fact as to whether the county?s policy of relying on professionals without training them on how to implement MSB procedures amounted to deliberate indifference.
Alternatively, the Ninth Circuit found that the county could be held liable for failure to implement policies regarding what to do if a patient suffered a fall, required transfer, or refused an essential medical treatment such as oxygen. The appeals court ruled that ?a county?s lack of affirmative policies or procedures to guide employees can amount to deliberate indifference, even when the county has other general policies in place,? but noted that this was the province of a jury to evaluate.
The appellate court concluded that since Long had presented ?sufficient probative evidence to create a triable issue regarding whether the county?s policies constituted deliberate indifference to [Idlet?s] constitutional rights which were the moving force behind his death,? it reversed and remanded the case for further proceedings. See: Long v. County of Los Angeles, 442 F.3d 1178 (9th Cir. 2006).
On February 27, 2007, on remand from the Ninth Circuit, the Los Angeles jail settled the case for $475,000.00. The county incurred attorney fees of $330,227.49 in defending the case. The settlement is available on the PLN website.
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Related legal case
Long v. County of Los Angeles
| Year | 2006 |
|---|---|
| Cite | 442 F.3d 1178 (9th Cir. 2006) |
| Level | Court of Appeals |
| Conclusion | Settlement |
| Damages | 475,000.00 |
| Injunction Status | N/A |