Lanman v. Hinson

RECOMMENDED FOR FULL-TEXT PUBLICATION

Pursuant to Sixth Circuit Rule 206

File Name: 08a0212p.06

UNITED STATES COURT OF APPEALS

FOR THE SIXTH CIRCUIT

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Plaintiff-Appellee, -

PATRICIA LANMAN,

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No. 06-2263

v.

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ROBERT HINSON, JAMES SIEGFRIED, MIKE MOREY, -

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LINDA SHAFFER-PRICE, GEORGE WHITE, JULIE

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STIVER, R.N., EDWINA KOEHN-KOLDENHOF, R.N.,

Defendants-Appellants. -

JEAN PRANDINE, STEVEN BRONSINK,

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Appeal from the United States District Court

for the Western District of Michigan at Grand Rapids.

No. 04-00122—Robert H. Cleland, District Judge.

Argued: November 29, 2007

Decided and Filed: June 17, 2008

Before: KENNEDY, MARTIN, and CLAY, Circuit Judges.

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COUNSEL

ARGUED: Mark E. Donnelly, OFFICE OF THE ATTORNEY GENERAL, Lansing, Michigan,

for Appellants. Heather A. Jefferson, FIEGER, FIEGER, KENNEY, JOHNSON & GIROUX,

Southfield, Michigan, for Appellee. ON BRIEF: Mark E. Donnelly, OFFICE OF THE

ATTORNEY GENERAL, Lansing, Michigan, for Appellants. Heather A. Jefferson, FIEGER,

FIEGER, KENNEY, JOHNSON & GIROUX, Southfield, Michigan, for Appellee.

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OPINION

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BOYCE F. MARTIN, JR., Circuit Judge. On January 5, 2002, Eugene Lanman was admitted

to Kalamazoo Psychiatric Hospital. The next day, while suffering psychiatric delusions, he attacked

a staff member. Lanman was immediately restrained by staff and administered medication to calm

him down. During the attempt to restrain Lanman, he stopped breathing and never regained

consciousness. He died seventeen days later after being taken off life support. His personal

representative brought this action against the staff of the hospital, alleging violation of Lanman’s

constitutional rights in transgression of 42 U.S.C. § 1983, abuse or neglect in violation of Michigan

1

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law, and assault and battery. The district court denied defendants’ motion for summary judgment

claiming qualified immunity on all of plaintiff’s claims, and defendants brought this interlocutory

appeal challenging that ruling.

I.

The decedent-plaintiff, Eugene Lanman, was a veteran with a history of mental illness. On

January 5, 2002, he was found wandering the countryside by the Kalkaska County Sheriff’s

Department. He was taken to the Antrim/Kalkaska County Community Mental Health Department

for a mental health assessment. Beverly Robinson conducted Lanman’s assessment and determined

that he needed in-patient psychiatric care on an emergency basis. She arranged for Lanman to be

transported to the Kalamazoo Psychiatric Hospital.

Lanman arrived at the psychiatric hospital at 9:30 p.m. that same night suffering from

auditory and visual hallucinations, suicidal ideations, and his legs were shaking uncontrollably. Dr.

S.B. Kondapaneni examined Lanman and determined he needed to be admitted to the hospital for

immediate psychiatric treatment. Dr. Kondapaneni determined that Lanman was a danger to himself

and was in need of intensive in-patient psychiatric care. Lanman was then admitted on a voluntary

basis when he filled out the Adult Formal Voluntary Admission Application.

Kondapaneni prescribed Celebrex for Lanman’s back pain and Vasotec for his blood

pressure. Kondapaneni did not prescribe any psychotropic drugs. Kondapaneni attempted to

determine whether Lanman was suffering from the side effects of having previously received

psychotropic drugs, but was unable to perform the requisite test at that late hour. After his

admission to the hospital, Lanman was directed to stay in a “quiet room,” a room which allowed

hospital staff to closely monitor Lanman. He was not given a room assignment, any psychiatric

treatment, or any psychotropic medications.

The next morning, after spending all night in a “quiet room” and still not having received

any treatment, Lanman was becoming increasingly agitated. He was pacing in circles in the

hallway, talking to himself, and trying to open the doors to other patients’ rooms. By 9:10 a.m.,

eleven hours after admission, Lanman was extremely upset. He was banging his head and hands on

the walls and doors, and not complying with staff requests to calm down and return to the “quiet

room.” Finally, staff requested he be medicated to calm him down. Dr. Van Putten ordered 2 mg

of Ativan be administered to Lanman. Defendant Nurse Edwina Koehn-Koldenhof went to the

medication room to draw the Ativan.

While Nurse Koldenhof was drawing the medicine, Lanman attacked resident care aide Mike

Morey, and attempted to choke him. Another aide, James Siegfried, attempted to grab Lanman from

behind, but Siegfried tripped and both Lanman and Siegfried fell to the ground. Siegfried asked

Lanman to calm down, but Lanman continued to struggle, flailing his arms and legs. When

Siegfried and Lanman fell to the floor, aides Linda Price and Morey immediately tried to restrain

Lanman’s legs. A “code easy” alarm had been sounded when Lanman attacked Morey, alerting

other hospital staff that help was needed. Aides Jean Prandine, George White, Tom Bissiden, Bob

Hinson, and Steve Bronsink all responded to the “code easy.” White relieved Morey and Price who

were attempting to control Lanman’s legs, but were being kicked violently by Lanman. Hinson

grabbed Lanman’s left arm and extended it up and away from Lanman’s body.

Nurse Koldenhof arrived with the Ativan and administered it. Nurse Julie Ann Stiver, who

had arrived in response to the “code easy,” ordered that Lanman be placed in restraints. While

Hinson was attempting to place a restraint on Lanman’s left wrist, someone stated there was a

problem and that Lanman wasn’t breathing. Lanman was turned on his back and Hinson

immediately started chest compressions. CPR was administered and paramedics were called.

No. 06-2263 Lanman v. Hinson, et al. Page 3

Lanman began breathing again and was taken by ambulance to Bronson Hospital. He never regained

consciousness and died after being taken off life support.

Plaintiff relies primarily on the deposition testimony of Richard P. Hunter, a fellow patient

at the hospital who witnessed the altercation. Hunter testified that he was sitting on a bench

approximately five feet from where Lanman was restrained. He stated that at least six individuals

held Lanman face down on the floor, and one of those individuals placed his knee in Lanman’s back

in attempt to hold him down. Hunter also testified that staff members had Lanman’s legs crossed

and were bending his legs back toward his head while Lanman was on his stomach. According to

Hunter, Lanman was having obvious difficulty breathing and was crying out for help because he

could not breathe. Two or three minutes later, Lanman was noticeably more calm, and a few

minutes after that looked as if he had passed out. Hunter stated that the staff ignored Lanman until

one of the nurses noticed he was passed out. Hunter gave a similar account to the Kalamazoo police

department when they interviewed him shortly after they arrived on the scene.

The personal representative of Lanman’s estate, Patricia Lanman, filed suit against

defendants Hinson, Siegfried, Morey, Price, White, Stiver, Koldenhof, Prandine, and Bronsink,

alleging violations of 42 U.S.C. § 1983; statutory abuse or neglect under Michigan law; and assault

and battery. Defendants moved for summary judgment asserting qualified immunity with regard to

Lanman’s § 1983 claim. The district court denied the defendant’s motion, and this interlocutory

appeal followed.

II.

This court reviews an order denying summary judgment on qualified immunity grounds de

novo. See v. City of Elyria, 402 F.3d 484, 490 (6th Cir. 2007). Summary judgment is proper “if the

pleadings, depositions, answers to interrogatories, and admissions on file, together with the

affidavits, if any, show that there is no genuine issue as to any material fact and that the moving

party is entitled to a judgment as a matter of law.” FED. R. CIV. P. 56(c). When deciding a motion

for summary judgment, this court views the evidence and draws all reasonable inferences in favor

of the non-moving party. Hardesty v. Hamburg Twp, 461 F.3d 646, 650 (6th Cir. 2006) (citing

Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 587 (1986)). Any direct evidence

offered by the plaintiff in response to a summary judgment motion must be accepted as true. Id.

Nevertheless, the “mere existence of some alleged factual dispute between the parties will not defeat

an otherwise properly supported motion for summary judgment; the requirement is that there be no

genuine issue of material fact.” Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 247-48 (1986).

A. Jurisdiction

This Court’s review of interlocutory appeals challenging a district court’s denial of qualified

immunity “is confined to the question of whether all of the conduct which the district court deemed

sufficiently supported for purposes of summary judgment met the Harlow standard of objective legal

reasonableness.” Farm Labor Org. Comm. v. Ohio State Highway Patrol, 308 F.3d 523, 537 (6th

Cir. 2002) (citations and internal quotation marks omitted). “If the defendant does not dispute the

facts alleged by the plaintiff for purposes of the appeal, ‘our jurisdiction is clear.’” Berryman v.

Rieger, 150 F.3d 561, 563 (6th Cir. 1998) (quoting Dickerson v. McClellan, 101 F.3d 1151, 1157

(6th Cir. 1996)). “If, instead, the defendant disputes the plaintiff’s version of the story, the

defendant must nonetheless be willing to concede the most favorable view of the facts to the plaintiff

for purposes of the appeal.” Id. “Only if the undisputed facts or the evidence viewed in the light

most favorable to the plaintiff fail to establish a prima facie violation of clear constitutional law may

we decide that the defendant is entitled to qualified immunity on an interlocutory appeal.” Id. (citing

Turner v. Scott, 119 F.3d 425, 428 (6th Cir.1997)).

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In defendants’ reply brief, they concede the most favorable view of the facts to the plaintiff,

and state that their appeal involves only the following purely legal issues: (1) the appropriate

standard under which to analyze plaintiff’s claims; (2) whether the law related to positional

asphyxiation of a patient who was physically struggling during an emergency situation in a mental

health institution was clearly established at the time; and (3) whether defendants’ actions were

objectively reasonable viewing the facts in the light most favorable to the plaintiff. Accordingly,

this Court has jurisdiction to review defendants’ interlocutory appeal of the district court’s denial

of qualified immunity.

B. Fourth Amendment v. Fourteenth Amendment

The parties dispute what constitutional standard is implicated by the facts of this case. This

is not a purely academic question as the standards of liability vary significantly according to which

amendment applies. See Darrah v. City of Oak Park, 255 F.3d 301, 306 (6th Cir. 2001) (“A

substantially higher hurdle must be surpassed to make a showing of excessive force under the

Fourteenth Amendment than under the ‘objective reasonableness’ test [of the Fourth Amendment]

. . . .”). Defendants here argue that plaintiff’s claim is governed by the Fourteenth Amendment

based on the holdings of the Supreme Court in Youngberg v. Romero, 457 U.S. 307 (1982), and this

Circuit in Terrance v. Northville Regional Psychiatric Hospital, 286 F.3d 834 (6th Cir. 2002).

Plaintiff suggests, and the district court agreed, that the Fourth Amendment applies.

The district court held that the facts of the case implicated the Fourth Amendment because

it read the Supreme Court’s decision in Graham v. Connor, 490 U.S. 386 (1989), to hold that all

excessive force claims should be analyzed under the Fourth Amendment reasonableness standard,

rather than the Fourteenth Amendment “substantive due process” approach. Id. Subsequently, the

Supreme Court clarified that Graham v. Connor “does not hold that all constitutional claims relating

to physically abusive government conduct must arise under either the Fourth or Eighth

Amendments; rather, Graham simply requires that if a constitutional claim is covered by a specific

constitutional provision, . . . the claim must be analyzed under the standard appropriate to that

specific provision, not under the rubric of substantive due process.” United States v. Lanier, 520

U.S. 259, 272 n. 7 (1997).

We have held that “[w]hich amendment applies depends on the status of the plaintiff at the

time of the incident, whether free citizen, convicted prisoner, or something in between.” Phelps v.

Coy, 286 F.3d 295, 299 (6th Cir. 2002) (citing Gravely v. Madden, 142 F.3d 345, 348-49 (6th Cir.

1998)). If the plaintiff was a convicted prisoner at the time of the incident, then the Eighth

Amendment deliberate indifference standard sets the standard for an excessive force claim.

Graham, 490 U.S. at 395 n. 10. But if the plaintiff was a free person, and the use of force occurred

in the course of an arrest or other seizure, then the plaintiff’s claim arises under the Fourth

Amendment and its reasonableness standard. Id. at 395. While this is seen most clearly in the law

enforcement setting of arrests or investigatory stops, Graham, 490 U.S. at 395, the Fourth

Amendment also applies in the civil setting to seizures of individuals for psychiatric evaluations or

involuntary confinement. Monday v. Oullette, 118 F.3d 1099, 1102-04 (6th Cir. 1997). Thus, the

Fourth Amendment reasonableness standard generally applies any time a government official seizes

a free citizen with the purpose of potentially creating an involuntary custodial relationship with the

State. Because the Fourth Amendment’s protection against unreasonable seizures “seems primarily

directed to the initial act of restraining an individual’s liberty,” Phelps, 286 F.3d at 301 (quoting

Valencia v. Wiggins, 981 F.2d 1440, 1444 (5th Cir. 1993)), we have stated that the standard applying

to a pretrial detainee’s excessive force claim “lies in the murky area between the Fourth and Eighth

Amendments,” Phelps, 286 F.3d at 300. At the very least, we have held that “the Fourteenth

Amendment . . . ‘Due Process Clause protects a pretrial detainee from the use of excessive force that

amounts to punishment.’” Phelps, 286 F.3d at 300 (quoting Graham, 490 U.S. at 395 n.10). The

Fourteenth Amendment is the source of a pretrial detainee’s excessive force claim because when a

No. 06-2263 Lanman v. Hinson, et al. Page 5

plaintiff is not in a situation where his rights are governed by the particular provisions of the Fourth

or Eighth Amendments, the more generally applicable Due Process Clause of the Fourteenth

Amendment provides the individual with protection against physical abuse by officials. Id.

In Youngberg, the Supreme Court held that the Fourteenth Amendment provides

involuntarily committed individuals with the right to be free from undue bodily restraint in the

course of their treatment by the State. 457 U.S. at 324. Even though by bodily restraining a patient

State actors are using physical force to restrain the liberty of a citizen, Graham, 490 U.S. at 395 n.

10 (“A ‘seizure’ triggering the Fourth Amendment's protections occurs . . . when government actors

have, ‘by means of physical force or show of authority, . . . in some way restrained the liberty of a

citizen.’”), the constitutional right recognized by Youngberg is not governed by the specific

provisions of the Fourth Amendment. This is because the act of physically restraining the patient

is for the purpose of medical treatment, which the State has determined is a necessary condition of

the patient’s confinement.

Likewise, a voluntarily confined individual who is bodily restrained by State actors, related

to his consented-to medical treatment, has not been seized for purposes of the Fourth Amendment’s

application so long as a reasonable person in the patient’s position would believe that he was free

to leave the State’s care. See Michigan v. Chesternut, 486 U.S. 567, 573 (1988). If, however, a

reasonable person in the patient’s position would believe that the physical restraint was not medical

treatment, but rather an attempt by the State to transform the voluntary care relationship into

involuntary confinement, then the patient has been seized within the meaning of the Fourth

Amendment and its standard applies.

Because at the time of the incident, Lanman was not in a situation where his rights were

governed by the particular provisions of the Fourth Amendment, we find that the more generally

applicable Fourteenth Amendment Due Process Clause applies to his excessive force claim. The

Fourth Amendment is inapplicable here because defendants did not “seize” Lanman when they

bodily restrained him. By requesting voluntary admission to Kalamazoo Psychiatric Hospital,

Lanman consented to defendants providing him medical treatment. Defendants physically restrained

Lanman to prevent him from harming himself or others and to administer medication to calm him

down. A reasonable person in Lanman’s position, as a voluntarily admitted patient in a psychiatric

hospital, would believe that the restraint was part of the medical treatment he had authorized, and

not an attempt by defendants to keep him there against his will. While the facts viewed in the light

most favorable to plaintiff suggest that Lanman did ask defendants to get off of him so he could

breathe, there is no evidence to suggest that Lanman expressed a desire to leave the hospital and

defendants refused to allow him to do so. Therefore, Lanman was not seized within the meaning

of the Fourth Amendment.

We find that the appropriate source for Lanman’s excessive force claim is the Fourteenth

Amendment, which provides him, as a patient of a state care institution, with the constitutional right

recognized in Youngberg to freedom from undue bodily restraint in the course of his treatment.

Basing this right in substantive due process, rather than the Fourth Amendment, allows for balancing

the individual’s liberty interest against the State’s asserted reasons for restraining the individual’s

liberty while in its care. It also gives proper deference to the decisions of institutional professionals

concerning medical treatment.

The district court relied on DeShaney v. Winnebago County Dep’t of Social Serv., 489 U.S.

189 (1989), for the proposition that it was the involuntary nature of the individual’s confinement that

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invoked the Fourteenth Amendment’s protections in Youngberg and Terrance.1 Therefore, it held,

because Lanman voluntarily committed himself to Kalamazoo Regional Psychiatric Hospital

(“KPH”) by signing an admission application, and was theoretically free to leave at any time, he was

not owed any duties under the Fourteenth Amendment. We disagree.

DeShaney does not address a situation in which the State itself, by the affirmative acts of

its agents, infringes on an individual’s constitutionally protected liberty interests. The Court in

DeShaney recognized that the protections of the Due Process Clause may be triggered when the

State affirmatively acts and subjects an involuntarily confined individual to deprivations of liberty

which are not among those generally authorized by his confinement. 489 U.S. at 200 n. 8.

Likewise, the Due Process Clause would protect a voluntarily confined individual from deprivations

of liberty by state actors that exceed those authorized by his consent to treatment. The mechanism

which brought the individuals to the various facilities, whether considered “voluntary” or

“involuntary,” is not controlling; in either case they are entitled to freedom from undue restraint at

the hands of the State under the Fourteenth Amendment.

Differentiating Fourteenth Amendment cases from those governed by the Fourth Amendment

based on the voluntary or involuntary nature of the state’s custody would lead to arguably

inconsistent results. In the present case even though Lanman was technically voluntarily committed,

under Michigan law, once he gave the hospital notice of his intent to leave, the hospital could retain

him against his will for up to three days. MICH. COMP. LAWS § 330.1419(1). Thus, applying the

district court’s reasoning, if Lanman had decided to leave the hospital, and been retained

involuntarily under § 330.1419(1), any § 1983 claims arising in those three days of involuntary

confinement would fall under the Fourteenth Amendment. But immediately prior to his decision

to leave, while his confinement was technically voluntary, the Fourth Amendment would apply to

any § 1983 claims. Under such a system, while Lanman’s relationship and dependence on the state

would not have changed, his constitutional protection would have. We do not believe such a

distinction is warranted.

1

The district court found the involuntariness argument determinative by reading DeShaney to mean that the

Constitution only imposes a duty on the State to assume responsibility for the safety of an individual when it has

“take[n] a person into its custody and holds him there against his will.” DeShaney, 489 U.S. at 199-200 (emphasis

added). But DeShaney decided only that the State is not responsible for the actions of third-party private actors against

individuals unless it had imposed restraints on the individuals' liberty to render them unable to care for themselves. Id.

at 200. The harms that occurred to the petitioner in DeShaney “occurred not while he was in the State's custody, but

while he was in the custody of his natural father, who was in no sense a state actor.” Id. at 201. Furthermore, the

DeShaney Court noted that the State had played no part in creating the dangers faced by the petitioner nor did it do

anything to render him any more vulnerable to them. Id. This is unlike the present case in which Plaintiff alleges that

the State, through the affirmative acts of Defendants, infringed on Lanman’s substantive due process right in freedom

from undue restraint while in the State’s custody. His status as voluntary or involuntary is irrelevant as to his

constitutional right to be free from the State depriving him of liberty without due process.

At this time, we do not need to decide whether the State owes the same affirmative constitutional duties of care

and protection to its voluntarily admitted residents as it owes to its involuntarily committed residents under Youngberg.

In an unpublished disposition, however, a panel of this Court held that because the plaintiff had been voluntarily admitted

to the state mental hospital, the State’s constitutional duty to protect those it renders helpless by confinement was not

triggered. Higgs v. Latham, No. 91-5273, 1991 WL 21646, at *4 (6th Cir. Oct. 24, 1991) (unpublished). Our sister

circuits are split on this issue. See Torisky v. Schweiker, 446 F.3d 438, 446-47 (3d Cir. 2006) (holding that while a

voluntary custodial relationship with the State is not a deprivation of liberty sufficient to trigger the protections of

Youngberg, a court commitment to state custody is not a necessary prerequisite--a voluntary commitment may become

involuntary in nature by state action); Walton v. Alexander, 44 F.3d 1297, 1303-04 (5th Cir. 1995) (recognizing that after

DeShaney, “if the person claiming the right of state protection is voluntarily within the care of custody of a state agency,

he has no substantive due process right to the state’s protection”); Monahan v. Dorchester Counseling Ctr., 961 F.2d

987, 992 (1st Cir. 1992) (finding no substantive due process right to safety under DeShaney because voluntary patient

was free to leave the facility); Society for Good Will to Retarded Children v. Cuomo, 737 F.2d 1239, 1245-46 (2d Cir.

1984) (finding Youngberg’s protections apply to voluntary and involuntary residents alike).

No. 06-2263 Lanman v. Hinson, et al. Page 7

Accordingly, we find that the Fourteenth Amendment governs plaintiff’s claim.

C. Qualified Immunity

Having found that Lanman was protected by the Due Process Clause of the Fourteenth

Amendment while voluntarily committed, we must now determine if his rights were violated.

Typically, this Court only has jurisdiction to review final decisions of district courts, and the “denial

of summary judgment is ordinarily not a final judgment.” Armstrong v. City of Melvindale, 432 F.3d

695, 698 (6th Cir. 2006) (citations omitted). A district court’s denial of a claim of qualified

immunity on summary judgment, however, is an appealable final decision, so long as the facts are

not disputed. Id. (citing Mitchell v. Forsyth, 472 U.S. 511, 530 (1985)). Here, as discussed above,

defendants concede to the facts viewed in a light most favorable to plaintiff, and claim only that

those facts do not demonstrate a violation of clearly established law as required to overcome the

affirmative defense of qualified immunity. Accordingly, this Court reviews the district court’s

denial of qualified immunity de novo under the usual summary judgment standard. Id. at 698-99.

Qualified immunity shields public officials who perform discretionary functions from tort

liability, so long as their conduct does not violate clearly established rights viewed under the

applicable constitutional standard, here, the Due Process Clause of the Fourteenth Amendment. Id.;

see also Harlow, 457 U.S. at 818. Qualified immunity is an affirmative defense that, once asserted,

shifts the burden of proof to the plaintiff to show that the defendant is not entitled to qualified

immunity. Sheets v. Mullins, 287 F.3d 581, 586 (6th Cir. 2002). The application of qualified

immunity is determined on a “fact-specific, case-by-case basis.” Armstrong, 432 F.3d at 699.

In order to determine whether a defendant is entitled to qualified immunity, this Court uses

a two-part test: “(1) whether, considering the allegations in a light most favorable to the party

injured, a constitutional right has been violated, and (2) whether that right was clearly established.”

Estate of Carter v. City of Detroit, 408 F.3d 305, 310-11 (6th Cir. 2005) (citing Saucier v. Katz, 533

U.S. 194, 201 (2001)).

A. Violation of a Constitutional Right

In order to determine whether a constitutional right has been violated, we must first decide

whether there exists a constitutional right under the Fourteenth Amendment to be free from

unnecessary restraint in a mental hospital. Specifically, plaintiff claims that the decedent’s rights

were violated when he was held face down even after he had stopped struggling and told them he

could not breathe, resulting in positional asphyxiation.

In Youngberg, the Supreme Court held that mental patients retain liberty interests in freedom

of movement and in personal security under the Fourteenth Amendment. 457 U.S. at 848-49.

However, those interests are not absolute. Id. In order to determine “whether a substantive right

protected by the Due Process Clause has been violated, it is necessary to balance the liberty of the

individual and the demands of an organized society.” Terrance, 286 F.3d at 849 (quoting

Youngberg, 457 U.S. at 325). In the mental hospital context, that balance “only requires that courts

make certain that professional judgment in fact was exercised,” in order to adequately protect a

patient’s rights. Youngberg, 457 U.S. at 321. “In making such determinations, decisions made by

the appropriate professional are entitled to a presumption of correctness unless it is established that

the person responsible did not base the decision on accepted professional judgment.” Terrance, 286

F.3d at 849. While the actions of professional decisionmakers, defined as “person[s] competent,

whether by education training or experience, to make the particular decision at issue,” Youngberg,

457 U.S. at 323 n.30, are held to this professional judgment standard, the defendant resident care

aides are non-professional employees and are held only to a deliberate indifference standard. See

Shaw v. Stackhouse, 920 F.2d 1135, 1147 (3d Cir. 1990) (holding that defendant residential service

No. 06-2263 Lanman v. Hinson, et al. Page 8

aides were clearly nonprofessional employees subject only to a deliberate indifference standard).

To establish deliberate indifference, Plaintiff must show that defendant resident care aides knew of

and disregarded an excessive risk to Lanman’s health or safety. Terrance, 286 F.3d at 843. Whether

Defendants “had the requisite knowledge of a substantial risk [of serious harm] is a question of fact

subject to demonstration in the usual ways, including inference from circumstantial evidence . . . and

a factfinder may conclude that [Defendants] knew of a substantial risk from the very fact that the

risk was obvious.” Id. (citing Farmer v. Brennan, 511 U.S. 825, 842 (1994)).

This Court has consistently held that damage claims against government officials arising

from alleged violations of constitutional rights must allege, with particularity, facts that demonstrate

what each defendant did to violate the asserted constitutional right. Terrance, 286 F.3d at 842.

Here, the district court failed to separately analyze the constitutionality of the individual actions of

each defendant. While we find that there are issues of fact as to whether some defendants were

deliberately indifferent to Lanman’s medical needs, we also find that summary judgment should be

granted in favor of other defendants because plaintiff has failed to allege sufficient facts

demonstrating that their actions violated Lanman’s constitutional rights. We will examine the

alleged actions of each defendant in turn, taking into account Richard Hunter’s testimony that

Lanman was restrained in a dangerous manner after there was no longer need for restraint.

1. James Siegfried

Plaintiff’s allegations create a material issue of fact as to whether defendant, and resident

care aide, James Siegfried was deliberately indifferent to Lanman’s serious medical needs. The

altercation at issue began when Lanman lunged at defendant Mike Morey, a fellow resident care

aide, in an apparent attempt to choke him. In response, Siegfried attmpted to restrain Lanman from

behind. The two fell to the floor with Lanman on top of Siegfried. Siegfried rolled Lanman onto

his side. Lanman resisted restraint by violently thrashing and kicking at Siegfried and Morey. The

code easy alarm was sounded and other staff members arrived on the scene to assist. Siegfried tried

to gain control of Lanman’s arms by grabbing his wrists. Siegfried was relieved by another staff

member moments later. He remained on his knees behind Lanman, however, throughout the

altercation. Siegfried denies placing his hands on Lanman’s back to hold him down at any time.

Siegfried’s kneeling position at the top half of Lanman’s body, coupled with Richard Hunter’s

testimony that a staff member used his knees on Lanman’s back to hold him down creates an issue

of fact as to whether Siegfried restrained Lanamn in a manner that was deliberately indifferent to

his medical needs.

2. Mike Morey

Plantiff has also alleged sufficient facts to support a finding that defendant Mike Morey was

deliberately indifferent to Lanman’s serious medical needs. Morey attempted to restrain Lanman’s

legs during the struggle. Despite Morey’s testimony that it was not proper restraint technique to

cross a patient’s ankles and lift his feet towards the back of the patient’s head, defendant Robert

Hinson testified that he saw Morey employ such a technique. The affidavit of Gerald Shiener, M.D.,

states that this restraint position is unsafe for the patient because it interferes with his ability to

breathe. Therefore, these facts create a material issue as to whether Morey was deliberately

indifferent to Lanman’s medical needs.

3. George White

There is also a material issue of fact as to whether defendant George White’s actions violated

Lanman’s constitutional rights. White responded to the code easy alarm and came to the aid of the

other staff members trying to control Lanman’s legs. White testified that Lanman was being

restrained face down. In an attempt to restrain Lanman’s legs, White laid himself across Lanman’s

No. 06-2263 Lanman v. Hinson, et al. Page 9

buttocks and legs. White testified that he continued to hold Lanman down despite hearing him say

that he could not breathe. These facts, coupled with the testimony of Richard Hunter, that the staff

members continued to restrain Lanman face down on the floor despite the fact that he was having

obvious difficulty breathing, he was noticeably more calm after two to three minutes, and he wasn’t

breathing at all after about five minutes, reveal a genuine issue of fact as to whether White was

deliberately indifferent to Lanman’s medical needs.

4. Robert Hinson

Furthermore, plaintiff has alleged facts that create an issue as to whether defendant Robert

Hinson’s actions violated Lanman’s constitutional rights. Hinson arrived on the scene shortly after

the code easy alarm sounded. He grabbed Lanman’s left arm and wrist and extended it above his

head. Hinson was attempting to place a leather restraint on Lanman’s left wrist when he was alerted

to the fact that Lanman had stopped breathing. The fact that Hinson had physical contact with

Lanman at the time he ceased breathing and he was positioned near the top of Lanman’s body, where

Richard Hunter testified that he saw someone place their knee on Lanman’s back and use his body

weight to hold Lanman face down, is enough to create an issue as to whether Hinson was

deliberately indifferent to Lanman’s medical needs.

5. Julie Stiver, R.N.

Moreover, even though defendant Julie Stiver, R.N., did not physically participate in the

restraint of Lanman, she may still be liable for a violation of Lanman’s constitutional rights under

a supervisory liability theory. As the supervisor of the restraint procedure, she can be held liable

for the actions of the resident care aides if she “at least implicitly authorized, approved or knowingly

acquiesced in the unconstitutional conduct of the offending subordinate[s].” Bellamy v. Bradley,

729 F.2d 416, 421 (6th Cir.1984) (citing Hays v. Jefferson County, 668 F.2d 869, 872-74 (6th

Cir.1982)). Defendant Julie Stiver, R.N., may also be liable for her own actions. As a professional

decisionmaker, competent because of her education, supervisory position, and NAPPI training to

decide to physically restrain Lanman and to use proper methods of restraint, she could only order

the physical restraint of Lanman to the extent professional judgment deemed this necessary to assure

the safety of himself or others. See Youngberg, 457 U.S. at 324. Her decision to restrain Lanman

in the manner defendants did is presumptively valid. Id. at 323. She will be liable for a

constitutional violation of his substantive due process right to be free from undue bodily restraint

only if her decision was such a substantial departure from accepted professional judgment that it

demonstrates that the manner in which defendants restrained Lanman was not based on such

judgment. Id.

In the present case, viewing the evidence in the light most favorable to the plaintiff, there is

a genuine issue as to whether defendant Julie Stiver, R.N., is liable for the deliberately indifferent

conduct of her subordinates and whether she is liable for her own actions as a professional

decisionmaker. Stiver ordered the staff to place ankle and wrist restraints on Lanman and supervised

the actions of the staff in attempting to do so. Because plaintiff has shown that Stiver was physically

present and directly supervising the staff as they restrained Lanman, plaintiff has demonstrated that

Stiver at least knowingly acquiesced in the alleged unconstitutional conduct of her subordinates.

Also, because the evidence viewed in the light most favorable to the plaintiff demonstrates that at

least some of the defendant resident care aides were deliberately indifferent, there is a genuine issue

as to whether Stiver’s actions show that she failed to exercise professional judgment in ordering and

supervising Lanman’s restraint.

6. Edwina Koehn-Koldenhof

In contrast to the above defendants, plaintiff has failed to allege sufficient facts to support

No. 06-2263 Lanman v. Hinson, et al. Page 10

a finding that the actions of defendant Edwina Koehn-Koldenhof, R.N., violated Lanman’s

constitutional rights. Koehn-Koldenhof’s only physical contact with Lanman consisted of

administering an injection of Ativan to calm him down. Plaintiff has not alleged that the injection

violated Lanman’s constitutional rights nor has plaintiff alleged that Koehn-Koldenhof supervised

the staff during the restraint procedure. Without more, Koehn-Koldenhof’s presence at the scene

and administration of Ativan are insufficient to support a finding that she violated Lanman’s

constitutional rights. Therefore, summary judgment should be granted in her favor.

7. Jean Prandine

Similarly, plaintiff has failed to allege sufficient facts to establish that defendant Jean

Prandine’s actions violated Lanman’s constitutional rights. According to her deposition testimony,

Prandine was one of the first to respond to the code easy alarm. She attempted to gain control of one

of Lanman’s kicking legs, but was almost immediately relieved by another staff member. Prandine’s

limited involvement in Lanman’s restraint does not subject her to individual liability for any alleged

constitutional violation that occurred. She should also be dismissed from the case.

8. Linda Shaffer-Price

Like Prandine, defendant Linda Shaffer-Price’s attempts to control Lanman’s legs for a few

moments before being relieved by defendant George White do not subject her to individual liability.

Because of her limited involvement, no material issue of fact exists as to whether Shaffer-Price was

deliberately indifferent to the decedent’s serious medical needs. Summary judgment should be

granted in her favor as well.

9. Steve Bronsink

Plaintiff has failed to allege sufficient facts to prove that defendant Steve Bronsink violated

Lanman’s constitutional rights. While it is alleged that Bronsink was present and perhaps involved

in Lanman’s restraint, plaintiff has failed to allege, with any particularity, the unconstitutionality of

Bronsink’s individual actions. Thus, summary judgment should be granted in his favor.

In sum, drawing all inferences in favor of plaintiff, a reasonable factfinder could conclude

that defendants James Siegfried, Mike Morey, George White, Robert Hinson, and Julie Stiver, R.N.,

restrained Lanman in a dangerous face-down position, with pressure on his back and possibly his

neck, with his ankles crossed and extended towards his head. They also could conclude that these

defendants ignored Lanman’s pleas for them to get off so he could breathe and failed to notice that

he was having “obvious difficulty breathing.” Indeed, under plaintiff’s version of the facts given

by eyewitness patient Richard Hunter, Lanman was “noticeably more calm” after two to three

minutes of struggling, and five minutes later, “he wasn’t resisting at all. He looked like he was

passed out.” According to Hunter’s account of the events, it was not until that point, when Lanman

had become unconscious, that one of the hospital staff members noticed he wasn’t breathing and the

hospital staff slowly got off of him, rolled him on his back, and began CPR. Again, viewing the

facts in the light most favorable to plaintiff, a jury could conclude based on the affidavit of Dr.

Werner U. Spitz that Lanman “died as a result of the consequences of positional asphyxia committed

by the defendant Hospital staff members,” and not as a result of Lanman’s underlying cardiovascular

disease, doxepin toxicity and extreme physical exertion as defendants assert.

Defendants had been trained under NAPPI (Nonabusive Physical and Psychological

Intervention) to never restrain a patient face down on the floor or put pressure on the patient’s back

because of the danger of suffocation. They also had been taught that they should cross a patient’s

ankles and pull the feet up towards the back of the head only as a technique to exit a seclusion room.

The facts taken in the light most favorable to plaintiff reveal that defendants used unapproved and

dangerous restraint techniques to control Lanman. The facts also show that defendants continued

No. 06-2263 Lanman v. Hinson, et al. Page 11

to use these dangerous techniques after two to three minutes of struggling when Lanman was

“noticeably more calm,” and five minutes later, when “he wasn’t resisting at all . . . [h]e looked like

he was passed out.”

Under these facts, a reasonable factfinder could find that defendants James Siegfried, Mike

Morey, George White, and Robert Hinson knew that their actions created a substantial risk of serious

harm to Lanman, yet they disregarded this knowledge by continuing to restrain him in a dangerous

manner for five minutes after he had ceased resisting. A reasonable factfinder could also conclude

that defendant Julie Stiver, R.N., as the nurse in charge of the restraint procedure, is liable for her

subordinates’ unconstitutional actions and/or that she substantially departed from professional

judgment in her supervision of the resident care aides’ deliberately indifferent actions. Therefore,

we find, viewing the facts in the light most favorable to plaintiff, that a reasonable factfinder could

conclude that defendants James Siegfried, Mike Morey, George White, Robert Hinson, and Julie

Stiver, R.N., violated Lanman’s Fourteenth Amendment substantive due process right to freedom

from undue bodily restraint. However, we also find that summary judgment should be granted in

favor of defendants Edwina Koehn-Koldenhof, R.N., Jean Prandine, Linda Shaffer-Price, and Steve

Bronsink because plaintiff has failed to allege sufficient facts demonstrating that their actions

violated Lanman’s constitutional rights.

B. Constitutional Right Was Clearly Established

However, even if defendants violated Lanman’s constitutional right, if at the time of the

alleged violations it would not have been clear to defendants that their actions were unlawful in the

situation they confronted, they are entitled to qualified immunity. Saucier v. Katz, 533 U.S. 194,

201-02 (2001). Officials do not enjoy qualified immunity simply because the exact conduct in

question has not previously been held unlawful by a court, but “in the light of pre-existing law the

unlawfulness must be apparent.” Anderson v. Creighton, 483 U.S. 635, 640 (1987). “[A]n action’s

unlawfulness can be apparent from direct holdings, from specific examples described as prohibited,

or from the general reasoning that a court employs.” Feathers v. Aey, 319 F.3d 843, 848 (6th Cir.

2003). Overall, “[t]he contours of the right must be sufficiently clear that a reasonable official

would understand that what he is doing violates that right.” Id.

Here, at the time of the alleged constitutional violation, it would have been clear to

defendants that their actions would violate Lanman’s Fourteenth Amendment substantive due

process right to be free from undue bodily restraint. It is not determinative that defendants’ exact

conduct has not previously been held unlawful by a court. In Youngberg, the Supreme Court

recognized that involuntarily confined patients in state institutions enjoy the right to freedom from

undue bodily restraint; bodily restraint is undue when and to the extent professional judgment deems

this unnecessary to assure safety or to provide treatment. 457 U.S. at 324. As we discussed supra,

the voluntary/involuntary distinction,2while perhaps relevant to whether the state has the duty to

protect patients from third-party harm, is irrelevant to the right of individuals, whatever their status,

to be free from physical abuse at the hands of the State. Thus, it would have been clear to

defendants that Lanman enjoyed the Fourteenth Amendment right to freedom from undue bodily

restraint recognized in Youngberg and reenforced by our Court in Terrance.

The facts viewed in the light most favorable to plaintiff demonstrate that defendants knew

because of their NAPPI training that restraining a patient face-down on the floor and putting

pressure on a patient’s back posed a substantial risk of asphyxiation. Despite knowledge of this risk,

defendants chose to restrain Lanman using these dangerous restraint techniques. Their actions were

2

We note, though, that the Second Circuit has found that Youngberg’s affirmative duties of care and protection

from third-party harm extend to voluntary and involuntary residents alike. Society for Good Will to Retarded Children

v. Cuomo, 737 F.2d 1239, 1245-46 (2d Cir. 1984).

No. 06-2263 Lanman v. Hinson, et al. Page 12

objectively unreasonable given the fact that plaintiff’s eyewitness testified that defendants continued

to restrain Lanman in this dangerous position five minutes after he wasn’t resisting at all and looked

like he was passed out. It would have been clear to defendants that it was not necessary to continue

restraining a patient who looked like he was passed out with techniques that pose a substantial risk

of asphyxiation. A reasonable official in defendants’ positions would understand that his actions

violated Lanman’s constitutional right to freedom from undue bodily restraint.

Therefore, we find that the right was clearly established at the time of Lanman’s restraint,

and defendants James Siegfried, Mike Morey, George White, Robert Hinson, and Julie Stiver, R.N.,

are not entitled to qualified immunity.

III.

A. Statutory Abuse and/or Neglect

The district court denied defendants’ motion for summary judgment on plaintiff’s claim for

statutory abuse and/or neglect under Michigan Compiled Law § 330.1722. That statute provides that

“[a] recipient of mental health services shall not be subjected to abuse or neglect.” MICH. COMP.

LAW § 330.1722(1). The statute further provides that “[a] recipient of mental health services who

is abused or neglected has a right to pursue injunctive and other appropriate civil relief.” Id. at

§ 330.1722(3). The district court held that the statute’s plain language created a private cause of

action, and that there is sufficient evidence that Lanman was subjected to abuse and neglect to defeat

summary judgment.

Defendants argue that there is no evidence of abuse or neglect as those two terms are defined

by Michigan law. They also argue that qualified immunity protects them from liability under

Michigan law.

With regard to defendants’ first argument, plaintiffs have presented enough evidence to

create a genuine issue of material fact as to whether abuse or neglect occurred. Michigan law

defines abuse as “nonaccidental physical or emotional harm . . . .” MICH. COMP. LAW

§ 330.1100a(2). It defines “neglect” as “an act or failure to act . . . that denies a recipient the

standard of care or treatment to which he or she is entitled under this act.” Id. at § 330.1100b(18).

Plaintiff has shown sufficient evidence that defendants restrained Lanman face down on the ground

by possibly placing their bodies or knees on his back following Lanman’s attack on Morey. Plaintiff

has also brought forth evidence that defendants ignored Lanman’s claims that he was having trouble

breathing, and continued to restrain him, even as he began to pass out. These facts, viewed in the

light most favorable to plaintiff, are enough to establish a cause of action for abuse or neglect under

Michigan law.

In order to defeat defendants’ claims for qualified immunity under Michigan law, plaintiff

must offer sufficient evidence of gross negligence. See MICH. COMP. LAW § 691.1407(2)(c). Gross

negligence is defined as conduct “so reckless as to demonstrate a substantial lack of concern for

whether an injury results.” Id. at § 691.1407(7)(a). Plaintiff has provided the following facts to

show defendants were grossly negligent under Michigan law: (1) defendants improperly restrained

Lanman face-down; (2) defendants applied significant pressure to his backside, with knowledge that

such pressure would make it difficult for Lanman to breathe; (3) defendants also disregarded his

pleas for help and his statements that he was having trouble breathing; and (4) defendants did not

notice that Lanman was passing out and continued to restrain him once he had gone limp. Relying

on our factual analysis under federal law with respect to each individual defendant, we hold that the

facts alleged are sufficient to establish a genuine issue of material fact and defeat defendants’ motion

for summary judgment and claims for qualified immunity under Michigan law with regard to

defendants James Siegfried, Mike Morey, George White, Robert Hinson and Julie Stiver, R.N.

However, plaintiff has failed to allege sufficient facts showing defendants Edwina Koehn-

No. 06-2263 Lanman v. Hinson, et al. Page 13

Koldenhof, R.N., Jean Prandine, Linda Shaffer-Price, and Steve Bronsink were grossly negligent

in attempting to restrain Lanman.

B. Assault and Battery

Plaintiff also brought a claim for assault and battery under Michigan law. The district court

denied defendants’ motion for summary judgment. On appeal, defendants argue that they were

legally justified in attempting to restrain Lanman because they were acting to protect themselves as

well as others from violence.

As the district court noted, in Michigan, an officer may use such force as is reasonably

necessary to effect a lawful arrest or seizure. Young v. Barker, 405 N.W.2d 395, 402 (Mich. Ct.

App. 1987). If an officer uses reasonable force in making a lawful seizure, then his actions are

justified, and he is protected by immunity under Michigan law. Id.; see also Brewer v. Perrin, 349

N.W.2d 198, 202 (Mich. Ct. App. 1984). “However, an officer who uses more force than is

reasonably necessary to effect a lawful arrest, commits a battery upon the person arrested.” White

v. City of Vassar, 403 N.W.2d 124, 130 (Mich. Ct. App. 1987). Applying these standards to

Lanman’s case, we come to the same conclusion reached above, that the district court did not err

when it denied summary judgment to defendants James Siegfried, Mike Morey, George White,

Robert Hinson and Julie Stiver, R.N. But we also find that plaintiff has failed to allege sufficient

facts to create a material issue of fact to maintain an assault and battery claim against defendants

Edwina Koehn-Koldenhof, R.N., Jean Prandine, Linda Shaffer-Price, and Steve Bronsink.

IV.

We find that the Fourteenth Amendment governs the constitutional right of voluntarily

committed mental health patients to be free from undue bodily restraint. We also find that the

plaintiff in this case has established a genuine issue of material fact under both his federal claim and

his state law claims with regard to defendants James Siegfried, Mike Morey, George White, Robert

Hinson and Julie Stiver, R.N. However, plaintiff has failed to allege sufficient facts to maintain his

claims against defendants Edwina Koehn-Koldenhof, R.N., Jean Prandine, Linda Shaffer-Price, and

Steve Bronsink. Thus, we AFFIRM the district court’s denial of defendants’ motion for summary

judgment claiming qualified immunity to plaintiff’s § 1983 claim with regard to defendants James

Siegfried, Mike Morey, George White, Robert Hinson and Julie Stiver, R.N., and REVERSE with

regard to defendants Edwina Koehn-Koldenhof, R.N., Jean Prandine, Linda Shaffer-Price, and Steve

Bronsink. We AFFIRM the district court’s denial of defendants’ motion for summary judgment on

plaintiff’s two state law claims with regard to defendants James Siegfried, Mike Morey, George

White, Robert Hinson and Julie Stiver, R.N., and REVERSE with regard to defendants Edwina

Koehn-Koldenhof, R.N., Jean Prandine, Linda Shaffer-Price, and Steve Bronsink.