The United States Court of Appeals for the Eighth Circuit reversed a lower court’s denial of qualified immunity to a guard who ordered a prisoner confined to a restraint board for more than three hours.

Minnesota prisoner Ronnie Jackson has a long history of mental health problems, prison rule violations and violent behavior. He has claimed to hear voices that tell him to slit his cellmate’s throat. For several years, he has been confined in an Administrative Control Unit (ACU), where he remains locked in his cell 23-hours a day.

ACU prisoners may request medical attention by sending a “kite.” If their condition is a life-threatening emergency situation, the prisoner may press a duress button in his cell. At about 7:20 a.m., on May 13, 2014, Jackson told a guard he was not feeling well. By noon, he was experiencing severe chest pains, nausea, shortness of breath, and vomiting, which he believed to be side effects of Effexor, which he took for depression.

During the next 90 minutes, Jackson repeatedly sought medical attention. He asked a nurse and a guard for assistance. When they declined, he pushed his emergency duress button three times. After his first two requests were ignored, a guard responded to the third request, telling Jackson “if you don’t stop pushing the button and harassing” guards “with fake requests for help you’ll be placed on the restraint board.”

Believing his medical condition was “dire,” Jackson began banging on his cell door at 1:38 p.m. When other prisoners realized Jackson needed medical assistance they banged on their cell doors too. “For appropriately 5 minutes staff completely ignored the noise,” said Jackson. Sergeant Donn Weber finally responded and activated an Incident Command System (ICS) response for a self-injurious prisoner, even though Jackson was not hurting himself.

When Lieutenant Jeff Gutzmer responded, Weber told him Jackson had been kicking and punching his cell door and ignoring orders to stop. Gutzmer claims that he feared Jackson might continue his self-injurious behavior if not restrained, so he ordered him placed on a restraint board.

Jackson was handcuffed, placed in leg restraints and moved by several guards to a table outside his cell. Two nurses examined Jackson and determined that he was not in distress or suffering from a medical condition that required immediate treatment or attention. The nurses medically cleared Jackson to be placed on the restraint board.

Guards were videotaped, placing Jackson face down on the restraint board at 2:00 p.m., with a towel under his head and restraint straps across his legs, back and head. A nurse made sure the restraints were not too tight. A guard told Jackson he would be allowed to use the bathroom “in a manner that maintains the safety of the staff and the offender.”

A mental health professional evaluated Jackson after he was restrained. Guards monitored his cell camera every 15 minutes and a nurse personally checked Jackson’s blood circulation every 30 minutes.

While restrained, Jackson repeatedly yelled and removed his head restraint. After a guard refused to let him use the bathroom, Jackson urinated on himself at about 4:25 p.m. Lieutenant Jeffrey White finally authorized Jackson’s removal from the restraint board at 5:25 p.m.

Jackson brought federal suit against guards and nurses, alleging that they subjected him to excessive force, in violation of the Eighth Amendment to the United States Constitution. The district court denied Gutzmer’s qualified immunity defense, but dismissed all other claims.