by Keith Sanders

On August 5, 2022, calling the medical neglect of a mentally ill detainee who refused treatment “objectively reasonable,” the U.S. Court of Appeals for the Fifth Circuit reversed a lower court’s denial of qualified immunity (QI) to defendants in a suit brought by the family of a pretrial detainee who died while in custody of the Bexar County Sheriff’s Department.

While experiencing a mental health crisis, Fernando Macias was shot by law enforcement officers during a standoff at his brother’s house on March 6, 2018. He was subsequently treated at a hospital and then taken into custody at Bexar County jail.

Macias’ medical history included myotonic dystrophy, hyper­tension, hyperthyroidism, and schizoaffective and delusional disorders. A court found him incompetent to stand trial in September 2018, but a backlog of patients in state hospitals left him in his jail cell until November 2018, when he was admitted to the jail’s infirmary. He was then taken to a hospital on December 15, 2018. While incarcerated, Macias had lost over a hundred pounds, developed pressure sores, and even lost toenails. He died of sepsis the next day.

His heirs sued Bexar County, Sheriff Javier Salazar, and Assistant Jail Administrator Laura Balditt. The Plaintiffs originally filed suit in the 131st Judicial District Court of Bexar County on December 14, 2020, prompting Defendants to remove the case to federal court for the Western District of Texas on March 1, 2021.

Plaintiffs subsequently amended their complaint under 42 U.S.C. §1983 to allege Fourth and Fourteenth Amendment violations for denial and delay of medical care, as well as claims regarding conditions of confinement, failure to supervise, and a claim under the Americans with Disabilities Act (ADA), 42 U.S.C. ch. 126 § 12101 et seq.

Plaintiffs argued that Sheriff Salazar and Balditt failed to provide Macias with mental health treatment required under the Sandra Bland Act, which took effect in September 2017, before his incarceration. In turn, they said this failure caused Macias to refuse dialysis, which hastened the deterioration of his health. The district court agreed and denied Defendants qualified immunity (QI) on October 25, 2021.

Defendants appealed to the Fifth Circuit, which reversed that decision. To overcome QI, the Court said, Plaintiffs must “allege (1) the violation of a federal constitutional or statutory right; and (2) that the right was clearly established at the time,” citing McClendon v. City of Columbia, 305 F.3d 314 (5th Cir. 2002).

In this case, the Court continued, “We begin and end with the second prong of the [QI] analysis—whether the right at issue was clearly established.” Citing Parker v. Blackwell, 23 F.4th 517, 522 (5th Cir. 2022), the Court said that “[s]howing that a right is clearly established ‘is difficult,’ and this showing is made only when ‘it is sufficiently clear that every reasonable official would have understood that what he is doing violates that right.’”

“[T]his court has held that it is not ‘clearly established that any jailer . . . must either force a conscious, incompetent, but clearly refusing inmate to undergo medical treatment or seek a surrogate decision-maker for the same,” the Court said, adding there is no “statutory duty [under Texas law] to impose medical care or locate a surrogate in these or similar circumstances,” citing Thompson v. Upshur Cty., 245 F.3d 447 (5th Cir. 2001).

“Although the plaintiffs allege that the defendants did not provide Macias with a psychiatrist or other mental health specialist while detained, they do not identify any precedent holding that doing so was constitutionally required where, as here, all agree that the detainee rejected most medical attention,” the Court concluded.

Thus, the district court’s ruling was held in error and reversed, and judgment was entered for Defendants. Macias’s heirs were represented in their suit by attorney U.A. Lewis with Lewis Law Group in Houston. See: Macias v. Salazar, 2022 U.S. App. LEXIS 21361 (5th Cir.).

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