Joe Marsh, Leroy Owens v. Butler County, Alabama, the Butler County Commission

BARKETT, Circuit Judge,

concurring in part and dissenting in part, in which TJOFLAT, MARCUS and WILSON, Circuit Judges, join.

I concur with the majority’s ultimate resolution of the claims against Sheriff Harris in her official capacity, the claims against Butler County, and Marsh and Owens’s deliberate indifference to serious risk of harm claims against the Sheriff in her individual capacity. I dissent, however, from the majority’s dismissal of Owens’s claim of deliberate indifference to his serious medical needs against the Sheriff in her individual capacity. I believe that the allegations in the complaint, taken as true and viewed in the light most favorable to Owens, are sufficient to withstand a motion to dismiss for failure to state this claim. Moreover, I believe that the law of deliberate indifference was sufficiently clear at the time of the incident that any reasonable government actor would have known that the alleged indiscriminate policy of releasing sick and injured inmates without guidelines that would have prevented the officers from abandoning Owens in his condition at 3:00 a.m. on the side of the road was unconstitutionally applied to Owens.

Federal Rule of Civil Procedure 8(a) requires that the plaintiffs complaint contain only, “(1) a short and plain statement of the grounds upon which the court’s jurisdiction depends, ... (2) a short and plain statement of the claim showing that the pleader is entitled to relief, and (3) a de.-mand for judgment for the relief the plead *1058 er seeks .... ” In Conley v. Gibson, 355 U.S. 41 , 78 S.Ct. 99 , 2 L.Ed.2d 80 (1957), the Supreme Court explained that Rule 8 “means what it says” in that the Rule does not “require a claimant to set out in detail the facts upon which he bases his claim. To the contrary, all the Rules require is ‘a short and plain statement of the claim’ that will give the defendant fair notice of what the plaintiffs claim is and the grounds upon which it rests.” Id. at 47 , 78 S.Ct. 99 . Consistent with this standard and cognizant of a plaintiffs limited ability to develop facts early in the litigation process, the Supreme Court held that “a complaint should not be dismissed for failure to state a claim unless it appears beyond a doubt that the plaintiff can prove no set of facts in support of his claim which would entitle him to relief.” Id. at 45-46 , 78 S.Ct. 99 ; see also Harder v. Blockbuster Entertainment Corp., 139 F.3d 1385 , 1387 (11th Cir.1998). Here, the complaint’s allegations, viewed in light of this standard, are sufficient to withstand the Sheriffs motion to dismiss.

“[D]eliberate indifference to serious medical needs of prisoners constitutes the ‘unnecessary and wanton infliction of pain’ proscribed by the Eighth Amendment.” Estelle v. Gamble, 429 U.S. 97, 104 , 97 S.Ct. 285 , 50 L.Ed.2d 251 (1976) (quoting Gregg v. Georgia, 428 U.S. 153, 173 , 96 S.Ct. 2909 , 49 L.Ed.2d 859 (1976)). In order to state such a claim against Sheriff Harris, Owens must allege that (1) he suffered from a serious medical need, (2) Sheriff Harris was deliberately indifferent to that need, and (3) Harris’s deliberate indifference caused him to suffer harm. See McElligott v. Foley, 182 F.3d 1248 , 1254-55 (11th Cir.1999). Moreover, deliberate indifference encompasses not only the failure to provide attention to an inmate’s medical needs, but also intentionally interfering with the inmate’s ability to receive prescribed health care. See Estelle, 429 U.S. at 105 , 97 S.Ct. 285 ; Ancata v. Prison Health Servs., Inc., 769 F.2d 700 , 704 (11th Cir.1985) (“Deliberate indifference to serious medical needs is shown when prison officials have prevented an inmate from receiving recommended treatment ....”) (quoting Ramos v. Lamm, 639 F.2d 559, 575 (10th Cir.1980)); see also Wakefield v. Thompson, 177 F.3d 1160, 1164 (9th Cir.1999) (holding that prison’s duty to provide medical care extends to period after release sufficient to allow former inmate to consult doctor and obtain new supply of medication). This is especially true where, as here, the plaintiffs injury is the result of the official’s own malfeasance and the release is at a time and place where the plaintiff stood little chance of receiving a prescribed treatment. This is not to say that the release of an inmate with a serious medical need always violates the Constitution. A jailer is not constitutionally required to provide for the continued medical care of a released inmate. The Constitution does require, however, that the release itself not be an act of deliberate indifference — i.e. that the release, or manner of release, is not an unreasonable response to a known medical need. Therefore, where, as here, the serious medical need is known by the officials, is created by the official’s conduct, and the inmate is released in an unreasonable manner where he has little or no chance of obtaining his prescribed treatment, there is the deprivation of a constitutional right.

Taking the allegations in the complaint as true, it cannot be gainsaid that the condition Owens alleged he was in when he was released by the hospital constituted a “serious medical need” and that the officers who took him from the hospital knew of his need. Owens’s head, neck and face were severely swollen and bruised, his lip had a hole torn through it, his ribs and chest were bruised and had been diag *1059 nosed as requiring continuing care and monitoring for his head injuries. The complaint alleged that the officers signed a release form acknowledging the need for the prescribed care. See Hill v. Dekalb Reg’l Youth Det. Ctr., 40 F.3d 1176 , 1187 (11th Cir.1994) (defining a serious medical need as “one that has been diagnosed by a physician as mandating treatment or one that is so obvious that even a lay person would easily recognize the necessity for a doctor’s attention”). Likewise, there can be no serious dispute that Owens sufficiently pled that the officers’ decision to ignore the instructions given to them at the hospital, and to instead abandon him barefoot, wearing bloodied clothing, severely swollen and bruised at 3:00 a.m. with little or no chance of securing his prescribed care, caused him to suffer harm.

Thus, in his claim against the Sheriff, the only question is whether Owens sufficiently alleged facts supporting the reasonable inference that the Sheriff was deliberately indifferent to his serious medical needs. The majority holds that Owens has not satisfied this requirement because he has not alleged that the Sheriff is “causally linked” to his constitutional deprivation. See, e.g., Rizzo v. Goode, 423 U.S. 362 , 96 S.Ct. 598 , 46 L.Ed.2d 561 (1976). Viewing the allegations in the complaint in the light most favorable to Owens, however, I believe that the complaint is sufficient to withstand the Sheriffs motion to dismiss.

As our case law recognizes, there are several ways Owens can establish the required causal link. Although § 1983 requires a connection between the official’s acts or omissions and the plaintiffs injury, “[pjersonal participation is only one of several ways to establish the requisite causal connection.... An official may also be liable where a policy or custom that [she] established or utilized results in deliberate indifference to an inmate’s constitutional rights.” Zatler v. Wainwright, 802 F.2d 397, 401 (11th Cir.1986) (internal citations omitted); see Swint v. City of Wadley, Ala., 51 F.3d 988, 999 (11th Cir.1995) (“ ‘[Liability may be imposed due to the existence of an improper policy or from the absence of a policy.’ ”) (emphasis added) (quoting Rivas v. Freeman, 940 F.2d 1491, 1495 (11th Cir.1991)).

Owens alleged that the officers acted with deliberate indifference to his serious medical needs pursuant to a policy and custom of indiscriminately releasing sick and injured inmates. Owens also alleged that the Sheriff was responsible for the development and implementation of any policy at the Jail pertaining to treatment of sick and injured inmates. The complaint further alleged that the Sheriff received a call from the Jail during the assault on Owens. Rather than crediting these allegations and viewing them in the light most favorable to Owens, the majority refuses to infer any content into the phone conversation and simply refuses to accept the allegation of the Sheriffs obligations regarding the development and implementation of a reasonable medical policy.

As to the phone call, the majority states, “Nothing alleges that the Sheriff was aware of who was being assaulted, the severity of the assault, or that an inmate would have to go to the hospital.” Majority at 1051 n. 14. However viewing the allegations regarding the phone call in the light most favorable to Owens, the phone conversation contained all of the relevant information. Although the Sheriff may not have known Owens’s name, the reasonable inference drawn from a phone call made during a serious assault at the jail in which inmates were screaming “They’re killing him up here,” to the Sheriffs home, in the middle of the night, by the only *1060 deputy on duty at the Jail, after the local police had refused to help break up the assault, is that the call was made to inform the Sheriff of the situation and to ask for her advice and help. Thus, it is reasonable to infer that the Sheriff was fully informed of the assault on Owens when she refused to come to the Jail, and it does not “appear beyond doubt” that Owens would be unable to prove these facts given the opportunity to conduct discovery.

Further, the majority’s refusal to credit Owens’s allegation regarding the development and implementation of the policy in effect at the Jail flies in the face of the bedrock jurisprudential principle that when ruling on a motion to dismiss the plaintiffs allegations must be taken as true. See, e.g., Hughes v. Rowe, 449 U.S. 5 , 101 S.Ct. 173 , 66 L.Ed.2d 163 (1980); Cruz v. Beto, 405 U.S. 319 , 92 S.Ct. 1079 , 31 L.Ed.2d 263 (1972); Womack v. Runyon, 147 F.3d 1298 (11th Cir.1998). The majority rejects Owens’s allegation regarding the existence of a policy stating that unsupported conclusions of law will not prevent a Rule 12(b)(6) dismissal. The existence and content of a policy, or the lack thereof, however, is a factual, not a legal, allegation. Moreover, the Supreme Court has held that in reviewing a complaint alleging the existence of a custom or policy, the plaintiffs allegations are to be taken as true and no particularized allegations are required to survive a motion to dismiss. 1 See Leatherman v. Tarrant County Narcotics Intelligence & Coordination Unit, 507 U.S. 163, 167-68, 113 S.Ct. 1160 , 122 L.Ed.2d 517 (1993).

Accordingly, I believe Owens alleged sufficient facts to support a reasonable inference that the Sheriff was aware that Owens was being seriously assaulted and that she was aware that Owens would be released from custody — regardless of his condition — pursuant to the policy she developed. I agree with the majority that the policy is facially constitutional because it could be humanely applied. However, contrary to the majority, I believe that, in light of the circumstances that existed at the Jail, the policy posed an obvious -danger to inmates such that an allegation regarding the existence of the policy leads to the reasonable inference that the Sheriff was aware that the policy posed an exces *1061 sive risk of harm. Here, the Sheriff ran a jail that was in such poor condition, so understaffed, and so poorly managed that the facility itself posed an excessive risk of harm to inmates of which the Sheriff was aware. In such a circumstance, it is inevitable that inmates will be seriously injured, as Owens was here. A policy of releasing sick and injured inmates — regardless of the degree of injury — clearly poses an excessive risk of harm to those inmates and it is reasonable to infer that the Sheriff knew of this risk. I believe that these facts are sufficient to support a finding of deliberate indifference.

I also believe that the law was sufficiently clear at the time of the challenged action that qualified immunity does not bar civil liability for this claim. Under the doctrine of qualified immunity, government officials sued for damages for injuries arising out the performance of their discretionary functions must be “shown to have violated ‘clearly established statutory or constitutional rights of which a reasonable person would have known.’” Conn v. Gabbert, 526 U.S. 286, 290 , 119 S.Ct. 1292 , 143 L.Ed.2d 399 (1999) (quoting Harlow v. Fitzgerald, 457 U.S. 800, 818 , 102 S.Ct. 2727 , 73 L.Ed.2d 396 (1982)). As the Supreme Court has explained, “qualified immunity seeks to ensure that defendants ‘reasonably can anticipate when their conduct may give rise to liability,’ by attaching liability only if ‘[t]he contours of the right [violated are] sufficiently clear that a reasonable official would understand that what he is doing violates that right.’” United States v. Lanier, 520 U.S. 259, 270 , 117 S.Ct. 1219 , 137 L.Ed.2d 432 (1997) (citations omitted). “This is not to say that an official action is protected by qualified immunity unless the very action in question has previously been held unlawful; but it is to say that in the light of preexisting law the unlawfulness must be apparent.” Anderson v. Creighton, 483 U.S. 635, 640 , 107 S.Ct. 3034 , 97 L.Ed.2d 523 (1987) (citations omitted). “This inquiry ... must be undertaken in light of the specific context of the case, not as a broad general proposition ...Saucier v. Katz, 533 U.S. 194 , 121 S.Ct. 2151 , 2156, 150 L.Ed.2d 272 (2001). Thus, “the relevant, dispositive inquiry in determining whether a right is clearly established is whether it would be clear to a reasonable officer that his conduct was unlawful in the situation he confronted.” Id.

By July 4, 1996, the date of the alleged incident, preexisting law clearly established that Owens was entitled to the medical treatment that the doctors at Stabler Hospital had prescribed for his injuries. The Supreme Court held in 1976 that deliberate indifference is shown not only by failing to provide prompt attention to an inmate’s medical needs, but also by “intentionally interfering with treatment once prescribed.” Estelle, 429 U.S. at 105 , 97 S.Ct. 285 ; see also Ancata, 769 F.2d at 704.

The Eleventh Circuit has applied this principle of “intentional interference with prescribed treatment” on numerous occasions. See, e.g., Young v. City of Augusta, 59 F.3d 1160, 1169 (11th Cir.1995) (denying summary judgment where the evidence indicated that jail officials failed to dispense “the psychotropic drugs prescribed for her ... as directed”); Howell v. Evans, 922 F.2d 712 (11th Cir.), vacated as settled, 931 F.2d 711, 712 (11th Cir.), reinstated by unpublished order (11th Cir. June 24, 1991) (“the law was clearly established at the time of Howell’s death that if a reasonable official would have known that certain treatment was necessary, the refusal to provide or a delay in providing that treatment would constitute deliberate indifference and violate Howell’s Eighth Amendment rights”); Washington v. Dugger, 860 F.2d 1018, 1021 (11th Cir.1988) *1062 (finding that unavailability of prescribed medication and failure of officials to follow hospital instructions for treating inmate were material to determination of officials’ deliberate indifference); Aldridge v. Montgomery, 753 F.2d 970, 972 (11th Cir.1985) (reversing directed verdict for county officials who had faded to give an inmate, having just received stitches for a cut above his eye, “ice packs and aspirin prescribed by the doctor for pain upon his return to the jail”).

Owens alleged that he suffered from “serious medical needs” after being released from the hospital following his assault at the Jail. He claimed that the hospital staff “instructed the Sheriffs Department to follow specific procedures to care for his head wounds and other injuries. It instructed them to monitor his level of consciousness, pupils, vision, and coordination, and to call the hospital immediately if any change occurred.” His condition was diagnosed by a physician as mandating treatment and monitoring, and he was in a great deal of pain.

Had Owens been left in the hospital or otherwise been released in a manner that afforded him access to his prescribed medical treatment, such as with a family member or other responsible person, this would be a different case. However, the complaint alleges that rather than adhering to the written instructions they received when signing Owens out of the hospital, the officers released Owens, instructing him to sign his own bond, and dropped him off near an interstate outside of a motel at 3:00 a.m. Owens was barefoot, wearing bloodied clothing, and was severely swollen and bruised. When he stepped out of the officer’s car, the officer drove away. Owens was, understandably, unable to secure a room at that motel, and, after walking dazedly across the highway, he was also denied entrance to a restaurant. At that point, a city police officer picked him up and ordered a clerk at a Holiday Inn to rent a room to Owens. These allegations fit within the preexisting deliberate indifference case law outlined above and, therefore, Harris is not entitled to qualified immunity at this stage in the proceedings.

Accordingly, I believe that the original panel opinion reached the correct result and should be reinstated.