Cady v. Cumberland County Jail, 1st Cir. (2014)

7/26/2019 Cady v. Cumberland County Jail, 1st Cir. (2014)

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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.

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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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Cady v. Cumberland County Jail, 1st Cir. (2014)

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Transcript of Cady v. Cumberland County Jail, 1st Cir. (2014)