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United States Court of AppealsFor the First Circuit
No. 13- 2040
KATHERI NE M. CADY, as Personal Repr esent at i veof t he Est at e of Paul Vi ct or Gal ambos, I I I ,
Pl ai nt i f f , Appel l ee,
v.
BARBARA WALSH; MI CHAEL TRUEWORTHY; LI NDA WI LLI AMS,
Def endant s, Appel l ant s.
APPEAL FROM THE UNI TED STATES DI STRI CT COURTFOR THE DI STRI CT OF MAI NE
[ Hon. Nancy Tor r esen, U. S. Di st r i ct J udge]
Bef or e
Lynch, Chi ef J udge,Sel ya and Kayat t a, Ci r cui t J udges.
Mi chael E. Sauci er , wi t h whom Rober t C. Hat ch, Hi l l ar y J .Bouchard, and Thompson & Bowi e were on br i ef , f or appel l ant s.
Er i c M. Mehner t , wi t h whomHawkes & Mehner t , LLP was on br i ef ,f or appel l ee.
J une 4, 2014
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LYNCH, Chief Judge. Kat her i ne Cady, on behal f of t he
est at e of her son, Paul Vi ct or Gal ambos, I I I , br ought t hi s 42
U. S. C. 1983 act i on af t er Gal ambos' s deat h f r om sel f - i nf l i ct ed
i nj ur i es t hat he suf f er ed whi l e he was a pr et r i al det ai nee at t he
Cumber l and Count y J ai l ( CCJ ) . The act i on al l eged t hat empl oyees of
Cor i zon, I nc. , t he pr i vat e company pr ovi di ng heal t hcar e ser vi ces at
CCJ , wer e del i ber at el y i ndi f f er ent t o Gal ambos' s ser i ous medi cal
needs i n vi ol at i on of hi s Four t eent h Amendment r i ght s. The
def endant s sought summary j udgment , argui ng t hat t hey were wi t hi n
a cat egor y of pr i vat e empl oyees prot ect ed by qual i f i ed i mmuni t y by
vi r t ue of t hei r dut i es, and wer e al so ent i t l ed t o i mmuni t y on t he
part i cul ar f act s .
The di st r i ct cour t assumed dubi t ant e t hat t he empl oyees
f el l i nt o a cat egor y of pr i vat e empl oyees el i gi bl e f or qual i f i ed
i mmuni t y, and deni ed t he summary j udgment mot i ons f i l ed by
def endant s Mi chael Truewort hy, Barbara Wal sh, and Li nda Wi l l i ams,
al l empl oyees of Cor i zon. I t r easoned, af t er a det ai l ed r evi ew of
t he f act s, t hat t her e r emai ned mat er i al and di sput ed i ssues of f act
as t o t he cl ai ms agai nst al l t hr ee i ndi vi dual s whi ch pr ecl uded t he
gr ant of i mmuni t y at t hi s poi nt .
The t hree def endant s now appeal , ar gui ng t hat t hey ar e
ent i t l ed t o qual i f i ed i mmuni t y. The pl ai nt i f f , not i ng t her e ar e
mat er i al i ssues of f act i n di sput e, i ncl udi ng conf l i cts i n t he
opi ni ons of exper t wi t nesses, ar gues t hat t her e i s no appel l at e
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j ur i sdi ct i on under t he doct r i ne of J ohnson v. J ones, 515 U. S. 304
( 1995) , even i f t he def endant s wer e t heor et i cal l y el i gi bl e f or t he
pr ot ect i ons of qual i f i ed i mmuni t y. Li ke t he di st r i ct cour t , we
bypass t he quest i on of whet her qual i f i ed i mmuni t y i s categor i cal l y
unavai l abl e t o t hese def endant s, because t he di st r i ct cour t ' s
deni al of i mmuni t y t ur ned on f i ndi ngs t hat t her e remai n di sput ed
i ssues of mat er i al f act and i nf er ence. We do not have j ur i sdi ct i on
over t hi s i nt er l ocut or y appeal under J ohnson. We di smi ss t hi s
appeal f or want of appel l at e j ur i sdi ct i on.
I .
We have j ur i sdi ct i on over an i nt er l ocut or y appeal of a
deni al of summary j udgment on qual i f i ed i mmuni t y onl y i nsof ar as
t he appeal r est s on l egal , r at her t han f act ual gr ounds. See
J ohnson, 515 U. S. at 313. We t her ef or e summar i ze t he f act s i n t he
l i ght most f avor abl e t o the non- movi ng par t y, t aki ng as
unchal l enged any i nf er ences t hat t he di st r i ct cour t dr ew i n t hat
par t y' s f avor .
A. Backgr ound and Named Def endant s
Cor i zon i s a pr i vat e i ndependent cont r act or t hat pr ovi ded
heal t hcar e servi ces t o i nmat es at CCJ under a cont r act wi t h CCJ
ef f ect i ve J anuary 1, 2007 t hr ough December 31, 2009. 1 Cor i zon was
1 Cor i zon was pai d a management f ee f or i t s servi ces. I t i suncl ear f r om t he recor d what t he rel at i onshi p was bet ween cost si ncur r ed and t he management f ee. The par t i es have not adequatel ybr i ef ed t hat quest i on.
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r esponsi bl e f or heal t hcar e at CCJ , and t o t hat end devel oped a set
of gover ni ng pol i ci es and pr ocedur es. Cor i zon was al so r equi r ed t o
r egul ar l y conf er wi t h t he Cumber l and Count y Sher i f f or hi s desi gnee
concerni ng both exi st i ng heal t hcare pr ocedur es and any changes t o
t hose pr ocedur es.
1. Mi chael Truewor t hy
Def endant Mi chael Tr uewor t hy, a psychi at r i c Nur se
Pr act i t i oner , wor ked as a per di emempl oyee of Cor i zon f r omAugust
t hr ough December 2008, and r epor t ed di r ect l y t o Dr . Al f onso Corona,
Cor i zon' s psychi at r i st f or CCJ . Tr uewor t hy saw i nmat es f or
medi cat i on eval uat i on and management , and r enewed pr escr i pt i ons f or
i nmates who had al r eady been pr escr i bed t hose medi cat i ons. He was
never on- cal l dur i ng hi s empl oyment at CCJ , and was not pr esent at
t he f aci l i t y f or al l emer genci es. Gener al l y, soci al wor ker s at CCJ
woul d pr ovi de Tr uewor t hy wi t h l i st s of i nmat es f or hi mt o at t end t o
dur i ng hi s shi f t s.
2. Barbara Wal sh
Def endant Barbara Wal sh, a Regi st ered Nurse, became
Cor i zon' s di r ect or of nur si ng i n 2006, and she was empl oyed i n t hat
posi t i on dur i ng t he 2008 event s t hat gave r i se t o t hi s case. She
super vi sed t he i nf i r mar y and t he nur si ng st af f . She descr i bed CCJ
as "chaot i cal l y busy. " She r epor t ed di r ect l y t o Cor i zon' s Heal t h
Ser vi ces Admi ni st r at or , Di ane Nor t h. Nor t h i s not a named
def endant . Wal sh was a part y t o t he "const ant di scussi on among t he
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Cor i zon st af f " r egar di ng sendi ng i nmat es out t o t he emer gency r oom
( ER) . The cost of havi ng an i nmat e t r anspor t ed t o a l ocal ER by
ambul ance had r i sen dr amat i cal l y, and was near l y $3, 000 i n t he f al l
of 2008. Cor i zon appar ent l y want ed t o keep cost s cont ai ned, and
al so assur e that nur ses wer e per f or mi ng onl y medi cal l y necessar y
act i ons. I n l i ght of t hese concer ns, Wal sh i nst r uct ed t he nur si ng
st af f t o cont act her at any t i me, even when she was not on dut y, so
t hat she coul d assess a gi ven si t uat i on bef or e deci di ng t o send an
i nmat e out t o t he ER f or addi t i onal car e. Accor di ng t o t he
par t i es' st i pul at ed f act s, t he r eason gi ven f or t hi s pol i cy was
t hat "t he [ st af f nur ses' ] excuse of t hei r nur si ng l i censes bei ng at
r i sk was not an accept abl e basi s f or a deci si on t o send an i nmat e
out t o t he ER. "
3. Li nda Wi l l i ams
Def endant Li nda Wi l l i ams, a Li censed Cl i ni cal Soci al
Wor ker , was r esponsi bl e f or assessi ng i nmat es' cur r ent ment al
heal t h st at us. She under t ook t hese heal t h assessment s f r omout si de
i nmat es' cel l s, and never ent er ed Gal ambos' s cel l t o assess hi m.
When Gal ambos f i r st came t o CCJ , Wi l l i ams t ook part i n hi s i nt ake
and i ni t i al eval uat i ons and subsequent eval uat i ons. Fr omDecember
2 t hrough December 11, 2008, Wi l l i ams obser ved Gal ambos each day
and spoke wi t h hi m on some days.
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B. Event s at CCJ
Gal ambos ent ered CCJ as a pr et r i al detai nee on August 3,
2008, f ol l owi ng hi s ar r est f or r obber y, r ef usal t o submi t t o
ar r est , and vi ol at i on of bai l condi t i ons. He had an ext ensi ve
hi st or y of ment al i l l ness and subst ance abuse, was di agnosed at t he
t i me wi t h schi zoaf f ect i ve di sor der , had a hi st or y of sui ci de
at t empt s, and had pr evi ousl y r ecei ved i n- pat i ent psychi at r i c
t r eat ment .
On hi s ar r i val at CCJ , Gal ambos r esi st ed bei ng
f i nger pr i nt ed and headbut t ed an i nt ake of f i cer . Hi s condi t i on was
descri bed by t he pl ai nt i f f ' s exper t as "act i vel y psychot i c, "2 and
a j ur y coul d so concl ude. He i ni t i al l y r ef used hi s medi cat i ons and
he was pl aced on sui ci de watch, where he remai ned f or a f ew days.
At t hi s poi nt , Cor i zon' s ment al heal t h st af f , i ncl udi ng Wi l l i ams,
was awar e of Gal ambos' s hi st or y of ment al i l l ness. They had access
t o hi s past r ecor ds, i ncl udi ng f r om hi s st ay at an i n- pat i ent
t r eat ment pr ogr am at Spr i ng Har bor Hospi t al cal l ed ACCESS, wher e
Gal ambos had been admi t t ed i n the past , most r ecent l y i n J une 2008.
2 The t hr ee Cor i zon def endant s obj ect ed t o t he magi st r at e
j udge' s admi ssi on of st at ements f r om t he pl ai nt i f f ' s t wo exper t s,Dr . Gr assi an and Dr . J agmi nas, on t he gr ounds t hat t hey di d notr esearch st andards of ment al heal t h care f or i nmates and werer el yi ng on a mal pr act i ce st andar d of car e. The magi st r at e j udgedi d not conduct an exhaust i ve Rul e 702 i nqui r y, but al so over r ul edt he def endant s' obj ect i ons and i ncl uded sever al st at ement s f r omt heexper t s i n t he Recommended Deci si on.
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Dr . Gr assi an, one of t he pl ai nt i f f ' s exper t s, sai d t he r ecor d shows
no evi dence t hat Truewort hy ever r evi ewed t hose r ecor ds.
Gal ambos agr eed t o t ake an oral dose of Hal dol on August
6, at whi ch poi nt he was "st epped down" t o "psych" watch f r om
sui ci de watch. He was t aken of f psych watch on August 10.
Dur i ng September 2008, Gal ambos under went addi t i onal
eval uat i ons t hat r esul t ed i n a medi cat i on r ecommendat i on.
Tr uewor t hy of f er ed a r ecommendat i on and medi cat i on pl an on
September 12, whi ch r ecommended cont i nued use of t he medi cat i ons he
was on when he ent ered CCJ : Zypr exa ( f or psychosi s) and Cogent i n
( f or pot ent i al si de ef f ect s of Zypr exa) . Tr uewor t hy was awar e t hat
Gal ambos had a hi st ory of sui ci de at t empt s and bel i eved t hat
Gal ambos' s prognosi s was poor wi t hout proper medi cat i on management .
Nonethel ess, Truewort hy sai d he bel i eved t hat because Gal ambos was
" l ogi cal and i nvol ved" as of Sept ember 12, Tr uewor t hy di d not need
t o see hi m r egul ar l y. The pl ai nt i f f ' s exper t , Dr . Gr assi an, has
noted t hat on Sept ember 9, Gal ambos was observed to be act i vel y
psychot i c; Dr . Gr ass i an opi ned t hat Tr uewor t hy' s Sept ember 12 pl an,
whi ch l ef t Gal ambos' s medi cat i on r egi men unchanged, was a vi ol at i on
of "any st andar d of car e. " He al so opi ned t hat t he f ai l ur e of t he
r ecor d to note Gal ambos' s act i vi t y f r omSept ember t o November was
unaccept abl e.
By November , Wi l l i ams di d note t hat Gal ambos exhi bi t ed a
pat t er n of i r r egul ar accept ance of hi s medi cat i on. Ther e i s a
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di sput e over whet her CCJ coul d f or ci bl y admi ni st er medi cat i on t o
i nmates. On November 8, Gal ambos submi t t ed a medi cal r equest sl i p
aski ng t hat he be gi ven Seroquel i nst ead of Zypr exa. There was no
r esponse and, accor di ng t o t he pl ai nt i f f ' s exper t , t he r ecor d
cont ai ns no expl anat i on f or i gnor i ng Gal ambos' s r equest .
Tr uewor t hy and Dr . Cor ona had previ ousl y di scussed saf et y i ssues
sur r oundi ng pr escr i bi ng Ser oquel i n a cor r ect i onal set t i ng, but i t
was l i st ed on Cor i zon' s medi cat i on f or mul ar y at t he t i me.
On November 8, Gal ambos was pl aced i n maxi mum secur i t y
af t er assaul t i ng anot her i nmat e, and he r emai ned t her e unt i l
November 12. Dur i ng t hi s per i od, Gal ambos asked t o see t he
psychi at r i st and r ei t er at ed hi s medi cat i on change r equest . On
November 11, Debr a Koni eczko, a Li censed Cl i ni cal Soci al Worker who
had t r eat ed Gal ambos when he was i n t he ACCESS pr ogr am, vi si t ed
Gal ambos i n CCJ . Af t er meet i ng wi t h Gal ambos and obser vi ng t hat he
was "hi ghl y agi t ated and anxi ous, " "demonst r at i ng psychomotor
agi t at i on, " and was "di f f i cul t t o i nt er r upt , " Koni eczko spoke wi t h
a Cor i zon soci al worker about Gal ambos. The Cor i zon soci al worker
met wi t h Gal ambos and repor t edl y di d not obser ve the pr obl ems t hat
Koni eczko noted. Af t er Gal ambos was al l owed out of maxi mum
secur i t y on November 12, he cont i nued t o ask t o swi t ch t o Seroquel ,
sayi ng that Zypr exa made hi mf eel sedated i n the morni ng and unabl e
t o sl eep at ni ght .
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On November 15, Cor i zon accept ed f r om Gal ambos a si gned
"r el ease of r esponsi bi l i t y" f or m t hat al l owed hi m t o r ef use t he
Zypr exa. On November 17, he agai n asked t o see a psychi at r i st f or
a change i n medi cat i on, and al so asked f or a change of housi ng,
r epor t i ng t hat ot her i nmat es wer e t hr eat eni ng t o ki l l hi m. No
change i n medi cat i on t ook pl ace, and on November 17, Truewort hy
r enewed Gal ambos' s Zypr exa and Cogent i n pr escr i pt i ons.
Gal ambos' s char t i ndi cat es t hat at some poi nt on December
1, he compl et ed a "Request Sl i p" seeki ng ment al heal t h servi ces, on
whi ch he i ndi cated: " I need t o f i nd out what meds wi l l wor k f or
me. " Al so on December 1, Gal ambos met wi t h Truewor t hy t o di scuss
hi s medi cat i on si t uat i on f or t he f i r st t i me si nce Gal ambos began
r equest i ng new medi cat i on i n ear l y November . Gal ambos t ol d
Tr uewor t hy t hat he had not t aken t he Zyprexa f or a week.
Tr uewor t hy di d not di scuss subst i t ute medi cat i ons wi t h Gal ambos.
That Gal ambos was no l onger on hi s medi cat i on di d not concer n
Tr uewor t hy, because Tr uewor t hy "bel i eved t hat Gal ambos al r eady
woul d have had pr obl ems [ due t o st oppi ng hi s medi cat i on] si nce he
had not been t aki ng Zypr exa f or a whi l e" as of t hat dat e.
As of t hi s December 1 meet i ng, Truewort hy di scont i nued
al l of Gal ambos' s psychi at r i c medi cat i ons, whi ch meant t hat
Gal ambos woul d no l onger be of f ered medi cat i on on a dai l y basi s.
Tr uewor t hy di d not see Gal ambos agai n, and he mai nt ai ns t hat he
never saw Gal ambos' s December 1 Request Sl i p.
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Somet i me i n t he 24 hour s f ol l owi ng hi s meet i ng wi t h
Tr uewor t hy, Gal ambos ver bal l y t hreatened t o commi t sui ci de t o a
cor r ect i onal of f i cer . Soci al wor ker Wi l l i ams met wi t h Gal ambos on
December 2 t o di scuss t he t hr eat , and at t he meet i ng he t ol d her
t hat he was not ser i ous about commi t t i ng sui ci de and t hat he want ed
t o change hi s housi ng assi gnment so he was not housed wi t h
pedophi l es. Accordi ng t o Wi l l i ams, i t was common f or i nmat es t o
compl ai n about bei ng housed wi t h i nmates char ged wi t h sex cr i mes.
But accor di ng t o Dr . Gr assi an' s assessment of Gal ambos' s r ecor ds,
Wi l l i ams made no ef f or t t o det ermi ne whet her Gal ambos was or was
not housed wi t h pedophi l es and so di d not make t he di f f er ent i al
di agnosi s as t o whet her hi s f ear s wer e r easonabl e or del usi onal .
Dr . Gr assi an opi ned t hat Wi l l i ams shoul d have undert aken such an
i nqui r y. On December 2 Wi l l i ams was not concerned t hat Gal ambos
was sui ci dal based on her over al l assessment , whi ch i ncl uded t hat
Gal ambos t ol d her he was not sui ci dal . Dr . Gr assi an cal l ed
Wi l l i ams' s assessment at t hi s j unct ur e and f ai l ur e t o i nqui r e
f ur t her i nt o Gal ambos' s ment al st at e a "caval i er di smi ssal of hi s
sui ci dal i t y, " and opi ned t hat i t was "gr ossl y negl i gent " and "a
f ai l ur e t o meet her pr of essi onal r esponsi bi l i t i es. " The r ecor d
suggest s t hat Wi l l i ams di d not di scuss Gal ambos' s medi cat i on
si t uat i on wi t h hi m on t hi s dat e. The i nf or mat i on t hat he was not
on any medi cat i on was set f or t h i n hi s f i l e.
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Despi t e Wi l l i ams' s assessment , Gal ambos i n f act t r i ed t o
commi t sui ci de t hat ni ght . On t he eveni ng of December 2, Gal ambos
was f ound i n hi s cel l wi t h a sel f - i nf l i ct ed st ab wound i n hi s neck,
made wi t h a penci l t hat was f ound under hi s bed. The st ab wound
nar r owl y mi ssed hi s car ot i d ar t er y. The pl ai nt i f f char act er i zes
t hi s as a sui ci dal act i on and a si gn of how ver y si ck and i n need
of car e Gal ambos was. He was sent out si de t he j ai l t o Br i ght on
Fi r st Car e, an af f i l i at ed medi cal cent er , f or appr opr i at e medi cal
ser vi ces. He was pl aced on sui ci de watch upon hi s December 3
r etur n t o CCJ . On December 3, Wi l l i ams obser ved t hat Gal ambos was
t al ki ng t o hi msel f , l aughi ng, and st andi ng naked i n f r ont of t he
wi ndow. He was not r esponsi ve t o her at t empt s t o engage hi m i n
conver sat i on. Wi l l i ams pl aced a cal l t o Dr . Cor ona r egar di ng
Gal ambos' s condi t i on, and Dr . Corona recommended gi vi ng hi ma dose
of Abi l i f y, whi ch was done. The next day, Wi l l i ams agai n observed
Gal ambos and thought t hat he was t al ki ng t o someone who was not
t her e and di d not appear t o be thi nki ng coher ent l y.
On December 5 and 6, Gal ambos cont i nued t o r egr ess . He
r epor t ed t o Wi l l i ams t hat he was hear i ng voi ces and t hat he f el t
l i ke someone had "st ol en hi s br ai n. " Dr . Cor ona observed t hat
Gal ambos was " f l or i dl y psychot i c" when he exami ned hi mon December
6. Dr . Corona and Wi l l i ams both obser ved Gal ambos st andi ng on t he
t abl e i n hi s cel l , t al ki ng t o t he wal l . The Faci l i t y Hot Book
i ndi cates t hat on December 7 t he water was t ur ned of f i n Gal ambos' s
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cel l because he had been t r yi ng t o f i l l t he si nk and i nhal e t he
water . On December 8, Gal ambos' s condi t i on cont i nued t o worsen,
and he was unabl e t o hol d a conver sat i on.
I n t he af t er noon, Gal ambos di d what i s r ef er r ed t o at
sever al poi nt s i n t he recor d as a "swan di ve" : he st ood naked on
t op of t he t abl e i n hi s cel l , and whi l e a st af f member was t r yi ng
t o t al k hi mdown, he j umped i nt o t he ai r and spun around t o l and on
hi s upper back and shoul der s on t he cement f l oor of t he cel l . The
st af f member s were concerned and i mmedi at el y brought Gal ambos t o
t he medi cal uni t t o r ecei ve emergency at t ent i on. However , he was
not sent out t o a hospi t al t hat day f or t r eat ment of hi s i nj ur i es.
He was badl y br ui sed by t he f al l , and though t he
di agnosi s woul d not be conf i r med unt i l t wo days l ater when he was
sent out t o a hospi t al f ol l owi ng a di f f er ent i nci dent , he sust ai ned
sever al br oken r i bs and a t r ansver se pr ocess f r act ur e. One of t he
pl ai nt i f f ' s exper t s al so opi ned t hat Gal ambos l i kel y suf f er ed a
concuss i on and had a ser i ous head i nj ur y.
When Gal ambos was i n t he medi cal uni t f ol l owi ng t hi s
i nci dent , Di r ect or of Nur si ng Wal sh per f or med a " ' wal k t hr ough'
assessment " of hi m, but di d not document her obser vat i ons.
Gal ambos was pl aced on sui ci de observat i on i n a cel l i n t he medi cal
uni t , but was not admi t t ed t o the medi cal i nf i r mar y, wher e he woul d
have been seen by a doct or . Wal sh coul d not r ecal l Gal ambos
r ecei vi ng any x- r ay ser vi ces i n t he medi cal uni t ei t her . Wal sh
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asser t s t hat she di d not consi der t hi s i nci dent t o be an emer gency
si t uat i on, and t hat she consi der ed Gal ambos' s j ump f r om t he t abl e
"aber r ant behavi or " r at her t han a "ser i ous sui ci de at t empt . "
Unt i l t hi s poi nt , Wi l l i ams sai d t hat she f el t t hat CCJ
was capabl e of t r eat i ng Gal ambos. I t was onl y af t er t he "swan
di ve" i nci dent t hat Wi l l i ams f el t t hat Gal ambos shoul d be
t r ansf er r ed t o Ri ver vi ew, a psychi at r i c f aci l i t y. 3 Act i ng wi t hi n
her aut hor i t y, she then f axed t he t r ansf er r equest s f or Gal ambos
and anot her i nmat e on t he mor ni ng of December 9. She had not done
so f or Gal ambos bef or e and i n par t i cul ar had not done so af t er
Gal ambos st abbed hi msel f i n t he neck wi t h a penci l . Soon af t er
maki ng t hi s i nqui r y, she l ear ned t hat Ri ver vi ew di d not have t he
capaci t y t o admi t Gal ambos at t hat poi nt and t hat he woul d be put
on t he wai t i ng l i st . A Ri ver vi ew st af f member suggest ed t o
Wi l l i ams t hat Spr i ng Har bor , a pr i vat e hospi t al , mi ght be an
al t er nat i ve pl acement . Ther e i s no evi dence t hat Wi l l i ams
at t empt ed t o f ol l ow up on t he Spr i ng Har bor opt i on. Wi l l i ams di d
not cont act Dr . Cor ona at t hi s poi nt , nor di d anyone el se.
Rather t han bei ng pl aced i n some sor t of out si de medi cal
f aci l i t y, Gal ambos r emai ned i n hi s cel l , on sui ci de wat ch, i n t he
medi cal uni t .
3 Dr . Gr assi an has opi ned t hat had Gal ambos been i n apsychi at r i c hospi t al , he woul d not have had a t abl e or pl at f or mf r omwhi ch he coul d have done a swan di ve, and t he wal l s woul d havebeen padded.
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On December 10, Wi l l i ams f ound Gal ambos l yi ng on t he
f l oor of hi s cel l wi t h bl ood on hi s f ace. He was not r esponsi ve t o
her . A nur se t r eat ed hi s wounds, and Gal ambos t ol d her t hat he
f el l of f hi s t oi l et and was sui ci dal . Wi l l i ams pl aced a cal l t o
t he Mai ne At t or ney Gener al ' s Of f i ce t o expl or e t he possi bi l i t y of
secur i ng an expedi t ed t r ansf er t o Ri ver vi ew. Lat er t hat af t er noon,
a cor r ect i onal of f i cer obser ved Gal ambos l ur ch f orward and down and
af t er maki ng no at t empt t o br eak hi s f al l , hi t t i ng hi s nose and
f ace on t he f l oor . Thi s, i n addi t i on t o hi s i nj ur i es f r om t he
December 8 j ump f r om t he tabl e, woul d have caused hi m si gni f i cant
pai n. Wal sh spoke wi t h Gal ambos and asked i f she coul d gi ve hi m
some medi cat i on. He r esponded, "yes, I ' l l t ake anythi ng at t hi s
poi nt . " Based on t hi s consent , Wal sh sought and r ecei ved an order
f or a heavy dose of emergency psychot r opi c medi cat i on t o be
admi ni st er ed. I n t he vi ew of t he pl ai nt i f f ' s exper t , Gal ambos was
overdosed i n a danger ous manner , and t hat may have been a
cont r i but i ng f act or i n hi s deat h.
To deal wi t h Gal ambos' s obvi ousl y out - of - cont r ol
behavi or , sever al st af f member s, i ncl udi ng Wal sh and Heal t h
Ser vi ces Admi ni st r at or Nor t h, deci ded t hat t he use of r est r ai nt s
was necessar y. Gal ambos was put i nt o a pr o- r est r ai nt chai r ,
cover ed wi t h a bl anket t o pr eserve hi s pr i vacy, and was gi ven t hi s
heavy, emergency dose of medi cat i on bef ore he was st r apped i n. At
t hi s poi nt , he was obser ved t o be cal m and cooperat i ng. When he
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was st r apped i nt o the chai r at appr oxi matel y 2: 40 PM, he began
yel l i ng l oudl y. He was t ol d t hat he woul d be r el eased f r om t he
r est r ai nt chai r when he cal med down and st opped yel l i ng. One of
t he pl ai nt i f f ' s exper t s, Dr . J agmi nas, opi ned t hat gi ven Gal ambos' s
i nj ur i es f r om t he December 8 i nci dent - - i ncl udi ng br oken r i bs - -
bei ng st r apped i nt o a chai r woul d have been ver y pai nf ul . About
ni nety mi nut es l ater , af t er he had cal med down, he was r el eased
f r om t he r est r ai nt chai r , and was r el eased back t o hi s cel l i n t he
medi cal uni t at about 4 PM.
Wal sh bel i eved t he use of t he r est r ai nt chai r was
appr opr i at e because Gal ambos " was i n a cr i si s, " consi st i ng of "hi s
var i ous act i ons of sel f - har m, but al so . . . bei ng compl et el y
undr essed, ur i nat i ng, . . . and yel l i ng. " By cont r ast , t he
pl ai nt i f f ' s exper t s bel i eve t he appr opr i at e r esponse was not
over medi cat i on and r est r ai nt , but pl acement i n a psychi at r i c
hospi t al . Dr . Gr assi an has opi ned t hat under t he ci r cumst ances - -
and gi ven how br ui sed Gal ambos was f r om j umpi ng of f t he t abl e and
l andi ng on hi s back and shoul der s - - put t i ng hi mi n a r est r ai nt was
"ver y, ver y danger ous. " Dr . Gr assi an al so opi ned t hat t he
emergency dose of medi cat i on gi ven t o Gal ambos t hat af t ernoon
overmedi cat ed hi m i n a dangerous manner .
By 6 PM t hat eveni ng, af t er hi s r el ease f r om t he
r est r ai nt chai r , Gal ambos was obser ved paci ng and bangi ng hi s head
of f t he wal l i n hi s cel l . At about 6: 10 PM, he was gi ven an
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i nt r amuscul ar i nj ect i on of At i van whi l e of f i cer s rest r ai ned hi m.
The needl e broke of f t he syr i nge as t he medi cat i on was bei ng
admi ni st er ed, so af t er t he t r eat i ng nur se obt ai ned a new syr i nge,
Gal ambos r ecei ved t he f ul l dose at about 6: 20 PM. By 6: 30 PM, he
was naked on t he f l oor of hi s cel l , had ur i nat ed on t he f l oor , and
was l ar gel y i ncoher ent . The t r eat i ng nur se cal l ed Cor i zon' s
medi cal di r ect or , Dr . Todd Tr i t ch, 4 t o eval uate Gal ambos.
Dr . Tr i t ch f ound cont usi ons on t he f r ont of Gal ambos' s
head wi t h f r esh bl ood, al ong wi t h cont usi ons on hi s r i ght shoul der .
Dr . Tr i t ch recommended Gal ambos be sent t o t he hospi t al ER at Mai ne
Medi cal Cent er ( MMC) f or a compr ehensi ve assessment . The
r espondi ng emer gency medi cal t echni ci ans t hat ar r i ved t o take
Gal ambos t o t he ER were t ol d about Gal ambos' s most r ecent ,
pr esent i ng pr obl ems, but were not t ol d about Gal ambos' s somersaul t
f r om t he t abl e i n hi s cel l t wo days ear l i er . Wal sh asser t s that
t her e was no need t o advi se t he medi cal cent er about t hat i nci dent .
Gal ambos was admi t t ed t o MMC wi t h f r act ures of t he t r ansver se
pr ocess and mul t i pl e r i b f r act ur es, and was kept over ni ght at t he
hospi t al f or obser vat i on.
On December 11, Wi l l i ams, worki ng wi t h Gal ambos' s
at t or ney, began t he pr ocess of havi ng Gal ambos ci vi l l y commi t t ed so
t hat he coul d be t r ansf er r ed t o Ri ver vi ew upon hi s r el ease f r omt he
4 Pl ai nt i f f has st i pul at ed t he di smi ssal of her cl ai msagai nst Dr . Tr i t ch, and we do not di scuss t hem her e.
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emergency r oom. However , Ri ver vi ew r equi r ed i nt ake t o t ake pl ace
dur i ng t he f aci l i t y' s r egul ar hour s, and so Gal ambos coul d not go
di r ect l y f r om MMC t o Ri ver vi ew. He was di schar ged back t o CCJ at
around 5 PM on December 11. Upon hi s r et urn t o CCJ , Gal ambos was
housed i n a cel l under Sui ci de Wat ch Obser vat i on. That cel l was
under "one- on- one" wat ch, whi ch r equi r ed a CCJ cor r ect i onal of f i cer
t o keep const ant vi sual cont act on Gal ambos at al l t i mes. That
eveni ng, Gal ambos compl ai ned t o t he cor r ect i onal of f i cer s t hat he
was i n pai n, and he was gi ven i bupr of en. He t hen shoved t he paper
medi cat i on cup i nt o hi s nost r i l , wher e i t was r emoved by the nur se
on dut y wi t h t weezer s. Gal ambos was t hen gi ven a dose of Hal dol
" f or a psychi at r i c or behavi or al emer gency. "
At appr oxi matel y 7: 20 i n t he morni ng on December 12, a
cor r ect i onal of f i cer observed Gal ambos get up and t hen f al l f ace
down on t he f l oor , and t hen get up and f al l agai n, st r i ki ng hi s
head agai nst t he wal l . When t he st af f member s ent er ed hi s cel l t o
assi st hi m, t hey di scover ed t hat Gal ambos was not r esponsi ve and
had no pul se. He was pr onounced dead soon af t er .
The cause of deat h was l at er det er mi ned t o be acut e
pul monary t hr omboembol i , caused by deep l eg vei n t hr ombosi s, caused
i n t ur n by sel f - i nf l i ct ed bl unt f or ce t r auma. Accor di ng t o t wo
physi ci ans t est i f yi ng as exper t s on behal f of t he pl ai nt i f f , t he
heavy dose of emer gency medi cat i on on December 10 ( whi ch r ender ed
Gal ambos near l y comat ose) and t he use of t he pr o- r est r ai nt chai r
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f ol l owi ng t he i nj ur i es Gal ambos sust ai ned when he j umped of f t he
t abl e bot h si gni f i cant l y i ncreased t he r i sk of devel opi ng
t hr ombosi s and wer e l i kel y cont r i but i ng f act or s i n causi ng
Gal ambos' s deat h.
C. Pr ocedur al Hi st or y
On J anuary 9, 2012, Cady f i l ed a Thi r d Amended Compl ai nt
i n t he Di st r i ct of Mai ne r ai si ng a cl ai m under 42 U. S. C. 1983
t hat def endant s Tr uewor t hy, Wal sh, and Wi l l i ams5 wer e del i ber at el y
i ndi f f er ent t o Gal ambos' s ser i ous medi cal needs. 6 On Oct ober 24,
Tr uewor t hy, Wal sh, and Wi l l i ams each f i l ed a mot i on f or summar y
j udgment , ar gui ng t hat t hei r per f or mance di d not f al l so l ow as t o
const i t ut e del i ber at e i ndi f f er ence and t hat t hey wer e ent i t l ed t o
qual i f i ed i mmuni t y.
On March 22, 2013, t he magi st r ate j udge i ssued a
t hor ough, 86- page Recommended Deci si on denyi ng t he def endants'
mot i ons f or summar y j udgment . The r ecommendat i on expr essed doubt
5 Cady al so named Cumber l and County and several count yempl oyees as def endant s. The di st r i ct j udge gr ant ed al l of t hecount y def endant s' mot i ons f or summary j udgment , and t hey ar e noti nvol ved i n t hi s appeal .
Cor i zon, I nc. was al so a named def endant , and t he di st r i ctcourt deni ed i t s mot i on f or summary j udgment . The company has notappeal ed t hat deci si on; t he onl y cl ai ms bef or e us now ar e the onesagai nst def endant s Truewor t hy, Wal sh, and Wi l l i ams.
6 Cady al so br ought a cl ai m under t he anal ogous Mai ne Ci vi lRi ght s Act , Me. Rev. St at . t i t . 5, 4682. The par t i es do notdi sput e t hat t he t wo cl ai ms ar e anal yzed co- extensi vel y. SeeBer ube v. Conl ey, 506 F. 3d 79, 85 ( 1st Ci r . 2007) ( "The di sposi t i onof a 42 U. S. C. 1983 cl ai m al so cont r ol s a cl ai m under t he [ Mai neCi vi l Ri ght s Act ] . " ) .
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t hat t hese def endant s, as empl oyees of a pr i vat e cor por at i on
per f or mi ng st at e f unct i ons, woul d be ent i t l ed t o qual i f i ed i mmuni t y
under Ri char dson v. McKni ght , 521 U. S. 299 ( 1997) , but i n l i ght of
t he r el at i ve uncer t ai nt y sur r oundi ng t hat quest i on of l aw, t he
magi st r at e j udge i ncl uded an al t er nat i ve r ecommendat i on, i n whi ch
she assumed that qual i f i ed i mmuni t y woul d be avai l abl e t o t hese
def endant s.
Under t hat al t er nat i ve r ecommendat i on, t he magi st r at e
j udge concl uded t hat as t o each of t he t hree def endant s, t her e
r emai ned genui ne i ssues of f act i n di sput e as t o whet her t hei r act s
and omi ssi ons const i t ut ed del i ber at e i ndi f f er ence. See Cosci a v.
Town of Pembroke, 659 F. 3d 37, 39 ( 1st Ci r . 2011) ( "A st at e and i t s
subdi vi si ons are under a subst ant i ve obl i gat i on i mposed by the Due
Process Cl ause of t he Four t eent h Amendment t o r ef r ai n at l east f r om
t r eat i ng a pr et r i al det ai nee wi t h del i ber at e i ndi f f er ence t o a
subst ant i al r i sk of ser i ous har m t o heal t h. ") . On t hat basi s, t he
magi st r ate j udge r ecommended denyi ng the def endant s' mot i ons f or
summar y j udgment .
As t o each def endant , t he magi st r ate j udge concl uded t hat
even i f t hey wer e not cat egor i cal l y di squal i f i ed f r om cl ai mi ng
qual i f i ed i mmuni t y, t he r ecor d was suf f i ci ent f or a " r easonabl e
f i nder of f act " t o concl ude "based on t he evi dence and per mi ssi bl e
i nf erences t heref r om" t hat each def endant "knew or shoul d have
known t hat Gal ambos' s psychot i c condi t i on r ef l ect ed an ext r emel y
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ser i ous medi cal need t hat , i f l ef t unt r eat ed, woul d gener at e a
subst ant i al r i sk of ser i ous har m t o hi s heal t h and saf et y. " Cady
v. Cumber l and Cnt y. J ai l , No. 2: 10- cv- 00512, 2013 WL 3967486, at
*26, *28, *30 ( D. Me. Aug. 1, 2013) ; cf . Cosci a, 659 F. 3d at 39
( not i ng t hat f or pr et r i al det ai nees, pr oof of del i ber at e
i ndi f f er ence "r equi r es a showi ng of gr eat er cul pabi l i t y t han
negl i gence but l ess t han a pur pose t o do harm" and may "consi st of
showi ng a consci ous f ai l ur e t o pr ovi de medi cal servi ces wher e t hey
woul d be r easonabl y appr opr i at e" ) .
As t o Tr uewor t hy, t he magi st r at e j udge concl uded t hat a
j ury coul d f i nd t hat t he deci si on t o or der a st op t o t he of f er i ng
of pr escr i bed medi cat i ons on December 1 was an act of del i berate
i ndi f f er ence t hat may have been a subst ant i al f act or i n br i ngi ng
about Gal ambos' s r api d decompensat i on i n t he days t hat f ol l owed.
The magi st r at e j udge al so not ed t hat a r easonabl e j uror coul d
consi der t he absence of counsel i ng t o be f ur t her evi dence of
del i ber at el y i ndi f f er ent medi cal car e; Tr uewor t hy cont ends t hat
Cor i zon pol i ci es cal l ed f or counsel i ng at t he December 1 j unct ur e,
but al so cont ends " t hat t her e i s no evi dence t hat counsel i ng di d
not occur , even i f he di d not do i t hi msel f . "
The magi st r at e j udge f ound t hat based on t he r ecor d, a
r easonabl e f i nder of f act coul d have concl uded t he f ol l owi ng as t o
Wal sh: she knew about Gal ambos' s r api d r egr essi on i n December 2008;
she was di r ect l y i nvol ved i n hi s car e based on her t r i age
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r esponsi bi l i t i es; t he December 8 j ump f r om t he t abl e deserved an
emer gency response by heal t h pr act i t i oner s or , at t he l east ,
demonst r at ed a need t o change t he per mi ssi ve appr oach t o Gal ambos' s
r ef usal t o t ake hi s medi cat i on; t he f ai l ur e t o send hi m out t o t he
ER on December 8 was l i kel y r el ated t o t he f act t hat he had been
sent out on December 2 af t er t he penci l - st ab i nci dent ; t he December
10 i nci dent was a f or eseeabl e consequence of a del i ber at el y
i ndi f f er ent appr oach t o medi cal car e; t he use of t he r est r ai nt
chai r f ol l owed f r om a del i ber at el y i ndi f f er ent appr oach t o
Gal ambos' s care; and t hat t hese event s i nvol ved "super vi sory
acqui escence and par t i ci pat i on di r ect l y rel at ed t o t he
depr i vat i on. " Cady, 2013 WL 3967486, at *28.
Fi nal l y, as t o Wi l l i ams, t he magi st r at e j udge r ecogni zed
t hat t hough Wi l l i ams had t aken af f i r mat i ve st eps, i ncl udi ng an
unsuccessf ul December 9 ef f or t at havi ng Gal ambos t r ansf er r ed t o
Ri ver vi ew, t he t ot al pi ct ur e, t he deci si ons she made, and t he
t i mi ng of her act i ons coul d suppor t a f i ndi ng of del i ber at e
i ndi f f er ence i n l i ght of Gal ambos' s ever - escal at i ng psychosi s and
at t empt s at sui ci de:
Al t hough Wi l l i ams di d somethi ng or assessedsomet hi ng at each new st age of Gal ambos' ssl i de i nt o psychosi s, i t does not f ol l ow t hat
she i s i nsul at ed f r oml i abi l i t y on t hat basi s .Nor i s i t appr opr i ate at summary j udgment f orWi l l i ams t o expect t he cour t t o vi ew t he[ December 2] penci l st ab i nci dent assuper f i ci al or a mer e gest ur e, l et al one t ocol or t he ent i r e cour se of event s based on aneval uat i on of t he si gni f i cance of t hat one
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i nci dent . That event , whi ch a r easonabl ef i nder of f act coul d r egar d as a ser i oussui ci de at t empt , occur r ed more t han a weekbef ore Gal ambos' s deat h and the change i nmedi cat i on r ecommendat i on di d not change t hef act t hat Gal ambos cont i nued t o r ej ect
medi cat i on and cont i nued t o sl i de deeper i nt opsychosi s. Whi l e i t i s t r ue t hat Wi l l i ams i snot r esponsi bl e f or Gal ambos' s r ef usal t o takehi s medi cat i ons or f or t he exi st ence of at abl e i n hi s cel l , what i s of concer n her e i st he nat ur e of her r esponse i n l i ght of t heseand other f act s known t o her at t he t i me. Onepossi bl e f i ndi ng on t hi s r ecor d i s t hatWi l l i ams' s act s and omi ssi ons demonst r at eddel i ber at e i ndi f f er ence t o ser i ous medi calneeds and a subst ant i al r i sk of ser i ous har m.
I d. at *30 ( r ecor d ci t at i ons omi t t ed) ( emphasi s added) .
Af t er maki ng a de novo det er mi nat i on of al l mat t er s
addr essed by the magi st r at e j udge, t he di st r i ct cour t adopt ed t he
Recommended Deci si on i n f ul l . I n par t i cul ar , t he di st r i ct cour t
agr eed wi t h t he magi st r at e j udge' s " pr udent deci si on t o assume f or
t he sake of ar gument t hat t he Cor i zon def endant s are ent i t l ed t o
qual i f i ed i mmuni t y, " and agr eed t hat even i f qual i f i ed i mmuni t y
wer e avai l abl e as a def ense, i t woul d f ai l . I d. at *1. The cour t
deni ed t he def endant s' mot i ons f or summary j udgment , l eavi ng the
del i ber at e i ndi f f er ence cl ai ms f or t r i al . Thi s appeal f ol l owed.
I I .
Or di nar i l y, we hear appeal s onl y f r om f i nal or der s and
deci si ons. See 28 U. S. C. 1291; Whi t f i el d v. Muni ci pal i t y of
Faj ar do, 564 F. 3d 40, 45 ( 1st Ci r . 2009) . Cer t ai n col l at er al
or der s ar e essent i al l y "f i nal deci si ons" and ar e t her ef or e
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i mmedi atel y appeal abl e under 28 U. S. C. 1291. See Cohen v.
Benef i ci al I ndus. Loan Cor p. , 337 U. S. 541, 546 ( 1949) . To f i t
wi t hi n t hi s col l at er al or der doct r i ne, an or der must "[ 1]
concl usi vel y det er mi ne the di sput ed quest i on, [ 2] r esol ve an
i mpor t ant i ssue compl et el y separ at e f r om t he mer i t s of t he act i on
[ t he ' separ abi l i t y r equi r ement ' ] , and [ 3] be ef f ect i vel y
unr evi ewabl e on appeal f r om a f i nal j udgment . " P. R. Aqueduct &
Sewer Aut h. v. Met cal f & Eddy, I nc. , 506 U. S. 139, 144 ( 1993)
( quot i ng Coopers & Lybr and v. Li vesay, 437 U. S. 463, 468 ( 1978) )
( i nt er nal quot at i on mar k omi t t ed) .
Because the "qual i f i ed i mmuni t y def ense i s, i n par t , an
i mmuni t y f r om t r i al as wel l as an i mmuni t y f r om damage awar ds, " a
pr e- t r i al deni al of t he def ense may, i n some cases, be i mmedi at el y
appeal abl e. St el l a v. Kel l ey, 63 F. 3d 71, 73 ( 1st Ci r . 1995) ; see
Mi t chel l v. For syth, 472 U. S. 511, 530 ( 1985) . I n J ohnson v.
J ones, 515 U. S. 304 ( 1995) , t he Supreme Cour t l i mi t ed t he
ci r cumst ances i n whi ch a deni al of qual i f i ed i mmuni t y i s r evi ewabl e
on an i nt er l ocut or y basi s. The J ohnson Cour t hel d t hat a di st r i ct
cour t ' s concl usi on t hat a summar y j udgment r ecor d i n a qual i f i ed
i mmuni t y case r ai sed a genui ne i ssue of f act as t o whet her t he
def endant s were i nvol ved i n t he al l eged event s was not i mmedi atel y
appeal abl e under t he col l at er al or der doct r i ne. 515 U. S. 313- 18;
see Pl umhof f v. Ri ckar d, ___ S. Ct . ___, 2014 WL 2178335, at *5
( 2014) .
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J ohnson r el i ed i n par t on t he "separ abi l i t y" r equi r ement
of t he col l at er al or der doct r i ne. The Cour t r easoned:
Where . . . a def endant si mpl y want s t o appeala di st r i ct cour t ' s det er mi nat i on t hat t he
evi dence i s suf f i ci ent t o per mi t a par t i cul arf i ndi ng of f act af ter t r i al , i t wi l l of t enpr ove di f f i cul t t o f i nd any such "separ at e"quest i on - - one t hat i s si gni f i cant l ydi f f er ent f r om t he f act - r el at ed l egal i ssuest hat l i kel y under l i e t he pl ai nt i f f ' s cl ai m ont he mer i t s.
I d. at 314. Quest i ons of " evi dent i ar y suf f i ci ency" - - i . e. ,
whet her t he recor d i s capabl e of suppor t i ng a par t i cul ar f act ual
f i ndi ng, r at her t han a par t i cul ar l egal concl usi on - - "ar e not
suf f i ci ent l y di st i nct t o war r ant i nt er l ocut or y appeal . " Ml odzi nski
v. Lewi s, 648 F. 3d 24, 27 ( 1st Ci r . 2011) ; see al so St el l a, 63 F. 3d
at 75 ( hol di ng t hat J ohnson "per mi t s i mmedi at e r evi ew of a
qual i f i ed i mmuni t y cl ai mwhen t he i ssue appeal ed concerns not what
f act s t he l i t i gant s mi ght ( or mi ght not ) be abl e t o pr ove, but ,
r at her , whet her a gi ven set of f act s shows a vi ol at i on of a
f eder al l y pr ot ected r i ght ") . I f appel l at e cour t s wer e t o over l ook
t hi s separ abi l i t y pr obl em i n t he cont ext of f act - based qual i f i ed
i mmuni t y appeal s and accept j ur i sdi ct i on, t hose cour t s " may wel l be
f aced wi t h appr oxi mat el y t he same f act ual i ssue agai n, af t er
t r i al , " and i nt er l ocut or y revi ew woul d pr ove an unwi se use of
appel l at e r esour ces. J ohnson, 515 U. S. at 316- 17; see al so Tang v.
St at e of R. I . , Dept . of El der l y Af f ai r s, 120 F. 3d 325, 326 ( 1st
Ci r . 1997) ( " J ohnson' s l i mi t at i on on i mmedi at e r evi ew r est s
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pr i mar i l y on a pr udent i al desi r e t o avoi d br i ngi ng evi dent i ar y
di sput es t o t he appeal s cour t except as par t of a f i nal
j udgment . " ) .
I n appl yi ng J ohnson, we have sai d t hat "a summary
j udgment or der whi ch det er mi nes t hat t he pret r i al r ecor d set s f or t h
a genui ne i ssue of f act , as di st i ngui shed f r om an or der t hat
det er mi nes whet her cer t ai n gi ven f act s demonst r at e, under cl ear l y
est abl i shed l aw, a vi ol at i on of some f eder al l y pr ot ect ed r i ght , i s
not r evi ewabl e on demand, " at l east so l ong as t hat per cept i on i s
not i nf ect ed by an er r or of l aw. St el l a, 63 F. 3d at 74 ( emphasi s
added) . I t f ol l ows t hat a "di str i ct cour t ' s pr et r i al r ej ect i on of
a qual i f i ed i mmuni t y def ense i s not i mmedi at el y appeal abl e t o t he
ext ent t hat i t t ur ns on ei t her an i ssue of f act or an i ssue
per cei ved by t he t r i al cour t t o be an i ssue of f act. " I d. ( ci t i ng
J ohnson, 515 U. S. at 318- 20) ( emphasi s added) .
So t oo her e. The magi st r at e j udge' s opi ni on - - adopt ed
i n f ul l by t he di st r i ct cour t - - deni ed summar y j udgment on t he
basi s of t he concl usi on t hat t her e ar e genui ne i ssues of f act and
i nf er ence on t he del i ber at e i ndi f f er ence cl ai ms agai nst t hese t hr ee
def endant s. The opi ni on i ncl udes separ at e det er mi nat i ons as to
each def endant , makes cl ear what port i ons of t he r ecor d support
t hose det er mi nat i ons, and out l i nes at l engt h t he per mi ssi bl e
i nf er ences t hat t he magi st r at e j udge bel i eved a r easonabl e j ur or
mi ght dr aw f r om t he evi dence. Cf . Tang, 120 F. 3d at 326- 27
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( hol di ng t hat J ohnson pr ecl uded i nt er l ocut or y appeal even wher e t he
di st r i ct cour t di d not i dent i f y "speci f i c f actual i ssues or expl ai n
i t s r ul i ng" and si mpl y deni ed def endant s' mot i on f or summar y
j udgment because i t agr eed t hat " t he vast maj or i t y of t he f act s ar e
i n di sput e") .
Though t he def endant s urge us t o vi ew t hi s appeal as
pr esent i ng a pur e i ssue of l aw ( whet her t hey ar e ent i t l ed t o
qual i f i ed i mmuni t y i ndi vi dual l y as a mat t er of l aw on t he f act s) ,
t hey nowhere devel op t he ar gument t hat , even dr awi ng al l t he
i nf er ences as t he di st r i ct cour t concl uded a j ur y per mi ssi bl y
coul d, t hey ar e ent i t l ed t o j udgment as a mat t er of l aw. 7 Cf .
Car t er v. St at e of Rhode I sl and, 68 F. 3d 9, 12 ( 1st Ci r . 1995)
( hol di ng t hat J ohnson al so appl i es t o bar i nt er l ocut or y r evi ew of
di st r i ct cour t ' s concl usi ons as t o i nt ent because r esol vi ng mat t er s
of i nt ent "based on evi dent i ary pr of f ers at summary j udgment
ent ai l s a qui nt essent i al f act ual assessment ") ; St el l a, 63 F. 3d at
75 ( " [ W] e l ack t he power t o i nqui r e i nt o, or addr ess, . . . t he
f act - based quest i on of what t he evi dence does ( or does not ) show
7 The "pur el y l egal " quest i on of whet her t he qual i f i edi mmuni t y def ense i s even avai l abl e t o Tr uewor t hy, Wal sh, andWi l l i ams i s not necessar i l y di sposi t i ve her e. Even i f we wer e t oconsi der and deci de the quest i on of whet her t hey ar e ent i t l ed t o
r ai se a qual i f i ed i mmuni t y def ense, t hat deci si on woul d not , on i t sown, compel r eversal of t he deni al of summary j udgment i n thedef endant s' f avor , as t he di st r i ct cour t hel d t hat even i f t hedef ense wer e avai l abl e, i t f ai l s at t he summar y j udgment st ageher e. See Ml odzi nski , 648 F. 3d at 27- 28 ( not i ng t hat an i nt er esti n avoi di ng advi sory opi ni ons was one f act or mot i vat i ng J ohnson' scor e hol di ng) .
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concer ni ng whet her t he [ def endant s' ] act i ons vi ol at ed t he asser t ed
r i ght . . . . " ) .
The def endant s ar e cor r ect t hat we have "assumed
i nt er l ocut or y appel l at e j ur i sdi ct i on wher e def endant s have accept ed
as t r ue al l f act s and i nf er ences pr of f er ed by pl ai nt i f f s, and
[ wher e] def endant s argue that even on pl ai nt i f f s' best case, t hey
ar e ent i t l ed t o i mmuni t y. " Ml odzi nski , 648 F. 3d at 28. And we
may, consi st ent wi t h J ohnson, exer ci se r evi ew even wher e t he
def endant s accept t he pl ai nt i f f s' ver si on onl y f or t he sake of
argument . See 515 U. S. at 318; see al so Bert hi aume v. Caron, 142
F. 3d 12, 16 ( 1st Ci r . 1998) ( " [ A] def endant who concedes ar guendo
t he f act s f ound t o be di sput ed i s not bar r ed by J ohnson f r omt aki ng
an i nt er l ocut or y appeal on a l egal cl ai m t hat t he def endant i s
never t hel ess ent i t l ed t o qual i f i ed i mmuni t y on f act s not
cont r over t ed. " ) . However , t hat f or mul at i on does not conf er
j ur i sdi ct i on i n t hi s case. The def endant s' br i ef i ng bef or e us
pl ai nl y di sput es bot h t he f act s i dent i f i ed by the magi st r at e j udge
as wel l as t he i nf er ences pr of f er ed by t he pl ai nt i f f and deemed
r easonabl e by the magi st r at e j udge.
Wi t h r espect t o each i ndi vi dual def endant , t he
def endant s' br i ef i ng obj ect s t o t he way the di st r i ct cour t
const r ued t he f act s and ar gues t hat t he di st r i ct cour t and
magi st r at e j udge er r ed i n t hei r concl usi ons as t o what a reasonabl e
j uror coul d f i nd. Those f act - based ar gument s ar e i next r i cabl y
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i nt er t wi ned wi t h what ever "pur el y l egal " cont ent i ons ar e cont ai ned
i n t he def endant s' br i ef s: wer e we to at t empt t o separ at e the l egal
f r om t he f act ual i n or der t o addr ess onl y those ar gument s over
whi ch we mi ght per mi ssi bl y exer ci se j ur i sdi ct i on, we si mpl y woul d
not know wher e t o begi n. Cf . J ohnson, 515 U. S. at 318. I t i s not
mer el y t hat t he St at ement of Fact s i n t he def endant s' br i ef , as i n
most br i ef s, shades t he di st r i ct cour t ' s det er mi nat i ons i n a
f avor abl e manner . Such a t act i c woul d, on i t s own, be i nsuf f i ci ent
t o def eat j ur i sdi ct i on. Rat her , t he def endant s' br i ef r epeat edl y
at t acks t he di st r i ct cour t ' s f act ual concl usi ons, maki ng no ef f or t
t o separ at e f act - based ar gument s f r om "pur el y l egal " ones.
For exampl e, i n i t s t hr ee- page sect i on on Wal sh' s
l i abi l i t y, t he br i ef charact er i zes the di s tr i ct court ' s
det er mi nat i ons as "unsuppor t ed i n t he r ecor d" and "concl usory, " and
ar gues t hat "[ c] ont r ar y t o t he Di st r i ct Cour t ' s concl usi on, t he
f ai l ur e t o send Gal ambos f or emergency r oom car e was based on t he
j udgment of t he nur si ng st af f at t he t i me t hat Gal ambos di d not
have any i nj ur y r equi r i ng hospi t al t r eat ment . " As the def endant s
acknowl edge, t hi s asser t i on r uns di r ect l y count er t o t he di st r i ct
cour t ' s det er mi nat i on t hat
[ t ] he r ecor d i s suf f i ci ent t o per mi t a
r easonabl e f i nder of f act t o concl ude. . . t hat t he f ai l ur e t o send Gal ambos out onDecember 8 l i kel y rel at ed t o t he f act t hat hehad been sent out on December 2 f or t he penci lwound and Wal sh' s i nsi st ence that l oss of anur si ng l i cense was no good excuse f or a send-out .
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Cady, 2013 WL 3967486, at *28. Such a f act - based chal l enge woul d,
of cour se, not def eat j ur i sdi ct i on i f i t wer e advanced i n t he
al t er nat i ve. But nowher e i n t he def endant s' br i ef does ther e
appear any devel oped argument t hat t he def endant s ar e ent i t l ed t o
summar y j udgment even i f t he di st r i ct cour t ' s concl usi ons about t he
r ecor d were cor r ect .
Ot her such f act - based chal l enges abound. Though t he
di st r i ct cour t pl ai nl y det er mi ned t hat a r easonabl e f act f i nder
coul d concl ude t hat Wi l l i ams knew of t he r i sk t o Gal ambos af t er t he
December 2 penci l - st abbi ng i nci dent , t he def endant s' br i ef asser t s
t hat " [ c] ont r ar y t o t he Di st r i ct Cour t ' s concl usi on, an emer gency
t r ansf er t o a psychi at r i c f aci l i t y was not , i n . . . Wi l l i ams'
j udgment , r equi r ed unt i l af t er t he t abl e j ump. " Ther e i s no
ar gument t hat Wi l l i ams was not l i abl e even i f , as t he di st r i ct
cour t concl uded, she per cei ved such a r i sk. Si mi l ar l y, t hough t he
di st r i ct cour t concl uded t hat a r easonabl e j ur y coul d f i nd t hat
Tr uewor t hy f ai l ed t o address any i ssues wi t h Gal ambos pr i or t o
di scont i nui ng hi s medi cat i ons, t he def endant s' br i ef char act er i zes
t hat det er mi nat i on as " concl usory and unsuppor t abl e on t he
undi sput ed r ecor d, " but nowher e ar gues t hat i t i s i nsuf f i ci ent as
a l egal mat t er t o suppor t l i abi l i t y. That i ssue, l i ke t he ot her s
we ment i on ( and l i ke many ot her s r ai sed i n t he def endant s' br i ef )
r epr esent s " t he ver y t ype of f act ual di sput e t hat J ohnson hol ds t o
be pr emat ur e so f ar as appel l at e r evi ew i s concer ned. " Tang, 120
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F. 3d at 326. Because t he def endant s' br i ef so cl ear l y does not
"accept [ ] as t r ue al l f act s and i nf er ences pr of f er ed" by the
pl ai nt i f f , Ml odzi nski , 648 F. 3d at 28, we do not credi t t he
def endant s' assert i on, i n r esponse t o an ear l i er Or der t o Show
Cause f r omt hi s cour t , t hat t hey "accept t he f act ual j udgment s made
bel ow. "
Fi nal l y, t he def endant s' obj ect i on t o t he di st r i ct
cour t ' s anal ysi s of whet her t he const i t ut i onal r i ght s i n pl ay wer e
"cl ear l y est abl i shed" al so does not t r ansf or mt hi s appeal i nt o one
t hat t ur ns on a pur e i ssue of l aw. See St el l a, 63 F. 3d at 75
( concl udi ng under J ohnson that we can "exami ne t he exi st ence vel
non of a const i t ut i onal l y pr ot ect ed r i ght " but not t he f act - based
quest i on of what t he evi dence does or does not show) . The
def endant s do not separ at e t hei r qual i f i ed i mmuni t y ar gument s f r om
t hei r mer i t s- based ones, and nei t her set of ar gument s concedes,
even i f onl y f or t he sake of ar gument , t hat t he di st r i ct cour t was
cor r ect i n i t s det er mi nat i ons r egar di ng what i nf er ences wer e
permi ss i bl e on t he summary j udgment r ecor d. Because t he def endant s
f ai l t o pose even t he qual i f i ed i mmuni t y quest i on i n a manner t hat
woul d permi t us t o concl ude t hat " t he answer t o i t does not depend
upon whose account of t he f act s i s cor r ect , " see St el l a, 63 F. 3d at
75, we l ack t he aut hor i t y to pr ovi de an answer .
Thi s case f i t s squar el y wi t hi n J ohnson, and we do not
have j ur i sdi cti on t o r evi ew i t at t hi s st age.
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I I I .
Thi s appeal i s di smi ssed f or want of appel l at e
j ur i sdi ct i on. So or der ed.
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