Currie ex rel. Heirs of Okoro v. Chhabra

• Decision Date: 24 October 2013
• Docket Number: No. 12–2709.,12–2709.
• Citation: 728 F.3d 626
• Parties: Jaclyn CURRIE, as personal representative, Administrator for the Estate and on behalf of the Heirs of Phillip Okoro, Plaintiff–Appellee, v. Jogendra CHHABRA, et al., Defendants–Appellants.
• Court: U.S. Court of Appeals — Seventh Circuit

728 F.3d 626

Jaclyn CURRIE, as personal representative, Administrator for the Estate and on behalf of the Heirs of Phillip Okoro, Plaintiff–Appellee,

v.Jogendra CHHABRA, et al., Defendants–Appellants.

No. 12–2709.

United States Court of Appeals, Seventh Circuit.

Argued May 29, 2013.

Decided Aug. 20, 2013.

Rehearing and Rehearing En Banc Denied Oct. 24, 2013.

Russell R. Ainsworth (argued), Jon C. Loevy, Attorneys, Loevy & Loevy, Chicago, IL, for Plaintiff–Appellee.

Brad A. Elward (argued), Attorney, Heyl, Royster, Voelker & Allen, Peoria, IL, for Defendants–Appellants.

Before BAUER, WOOD, and TINDER, Circuit Judges.

WOOD, Circuit Judge.

Phillip Okoro spent the last 69 days of his short life—which ended two days before Christmas, on December 23, 2008, at age 23—in a Williamson County, Illinois jail cell. An autopsy determined that his death resulted from diabetic ketoacidosis, a life-threatening condition associated with untreated Type I diabetes. Jaclyn Currie, Okoro's sister and the administrator of his estate, brought suit in federal court, alleging violations of Okoro's federal constitutional rights and state law. Two of the named defendants, Dr. Jogendra Chhabra and Nurse Marilyn Ann Reynolds, were employees of a private company (Health Professionals, Ltd.) under contract to provide medical services to the county's inmates at the time of Okoro's death. Shortly before trial, Chhabra and Reynolds filed a motion to dismiss Currie's complaint, asserting qualified immunity on Currie's Fourth Amendment claims. The district court denied the motion, and Chhabra and Reynolds filed this interlocutory appeal. We affirm.

I

Okoro was arrested without a warrant at his residence on October 15, 2008, on suspicion of having committed a misdemeanor property crime. The Fourth Amendment “requires a prompt judicial determination of probable cause as a prerequisite to an extended pretrial detention following a warrantless arrest,” usually within 48 hours. See Cnty. of Riverside v. McLaughlin, 500 U.S. 44, 47, 111 S.Ct. 1661, 114 L.Ed.2d 49 (1991) (discussing Gerstein v. Pugh, 420 U.S. 103, 95 S.Ct. 854, 43 L.Ed.2d 54 (1975)). For unknown reasons, Okoro never received such a “Gerstein hearing” during his two months of incarceration.

Williamson County contracts with Health Professionals, Ltd. to provide medical care for arrestees and inmates held at the county jail. As a teenager, Okoro was diagnosed with Type I diabetes, which he was able to control with careful monitoring of his blood sugar levels. But his problems worsened while he was in college, when he was diagnosed with schizophrenia. The latter disease compromised his ability to monitor and care for his diabetes. Immediately after his arrest, Okoro's family members began calling the Williamson County jail to inform correctional employees and medical staff of Okoro's mental illness and diabetic condition. According to the complaint, during his time at the jail Okoro was under the care of Dr. Chhabra and Nurse Reynolds. For the most part, he was detained in his cell, usually in isolation, and thus he was dependent on jail employees and medical staff to monitor his blood sugar level, provide insulin shots, and deliver other necessary medical care.

On December 23, 2008, Okoro collapsed in his cell; he was pronounced dead at the Heartland Regional Medical Center. An autopsy revealed that Okoro's death was the result of diabetic ketoacidosis, a buildup of acidic ketones in the bloodstream that occurs when the body runs out of insulin. See Mayo Clinic Staff, Diabetic Ketoacidosis, http:// www. mayoclinic. com/ health/ diabetic- ketoacidosis/ DS 00674 (last visited Aug. 20, 2013). Currie's complaint alleges that Okoro's death was “completely preventable” and would not have occurred had Okoro received adequate medical care, including regular testing of his blood sugar levels and sufficient insulin to keep his blood sugar level steady.

Currie filed her initial complaint on October 14, 2009, naming as defendants various jail officials, Williamson County, Chhabra and Reynolds, and Health Professionals, Ltd. The initial iterations of her complaint alleged that the defendants acted with “deliberate indifference” to Okoro's medical needs, suggesting a claim that the defendants violated Okoro's due process rights under the Fourteenth Amendment. See Cavalieri v. Shepard, 321 F.3d 616, 620 (7th Cir.2003) (“The Eighth Amendment does not apply to pretrial detainees, but as a pretrial detainee, [Plaintiff] was entitled to at least the same protection [under the Due Process Clause] against deliberate indifference to his basic needs as is available to convicted prisoners under the Eighth Amendment.”). At the close of discovery, however, in response to the defendants' motion for summary judgment, Currie argued for the first time that the Fourth Amendment's “objectively unreasonable” standard should govern. See Williams v. Rodriguez, 509 F.3d 392, 403 (7th Cir.2007) (“[C]onditions of confinement for pretrial detainees ... who have not yet had a judicial determination of probable cause (a Gerstein hearing) are ... governed by the Fourth Amendment and its objectively unreasonable standard.”). The court accepted this argument, ordered Currie to file an amended complaint to reflect this theory, and dismissed without prejudice Currie's previous complaint. See Fed.R.Civ.P. 16(c)(2)(B); 6A Charles Alan Wright, Arthur R. Miller & Mary Kay Kane, Federal Practice and Procedure § 1525 (3d ed.2012).

Hours after this ruling, Currie settled with the jail officials and Williamson County, leaving Chhabra, Reynolds, and Health Professionals, Ltd. as the sole remaining defendants. Upon receipt of Currie's revised complaint alleging “objectively unreasonable” conduct, Chhabra, Reynolds, and Health Professionals filed a motion to dismiss, asserting qualified immunity “because the Fourth Amendment has not been applied to licensed medical professional[s] subcontracted to care for state detainees.” The court denied this motion. Only Chhabra and Reynolds are before us on appeal.

II

Before turning to the heart of the appeal, we must address Currie's argument that this court “lacks jurisdiction” to hear Chhabra and Reynolds's interlocutory appeal because their motion to dismiss “was procedurally improper.” Currie maintains that Chhabra and Reynolds should have asserted qualified immunity promptly when the district court ruled that it would use a Fourth Amendment framework to assess Currie's constitutional claims. Instead, they waited to receive Currie's amended complaint. The district court wasted little ink rejecting this argument as “disingenuous,” explaining that it was not until Currie filed her final amended complaint (which, for the first time, alleged that the defendants' conduct was “objectively unreasonable”) that her pleadings “reasonably suggested that the Fourth Amendment was applicable.”

There is no merit at all in this argument. To begin with, we remind parties again that there is no duty to plead legal theories. See, e.g., Alioto v. Town of Lisbon, 651 F.3d 715, 721 (7th Cir.2011); Hatmaker v. Mem'l Med. Ctr., 619 F.3d 741, 743 (7th Cir.2010); Aaron v. Mahl, 550 F.3d 659, 666 (7th Cir.2008). It therefore does not matter whether the complaint mentioned the Fourth Amendment, the Fourteenth Amendment, or neither, so long as it provided adequate notice of the plaintiff's claim to the defendants. As for qualified immunity in particular, even though ideally an immunity defense should be resolved at the earliest stage possible, Tamayo v. Blagojevich, 526 F.3d 1074, 1090 (7th Cir.2008), that is a guideline, not a rigid rule. Here, the district court did not abuse its discretion when it entertained the defendants' qualified immunity argument. See Jogi v. Voges, 480 F.3d 822, 836 (7th Cir.2007) (district court may, in its sound discretion, consider belated assertion of qualified immunity defense in procedurally complex cases). Nothing approaching a jurisdiction problem bars our consideration of the court's ruling.

III

On the merits, the defendants' first contention is that Currie has failed to state a claim, since “[t]he Fourth Amendment does not govern the provision of medical services to [a pre-Gerstein hearing] arrestee by a contracted medical care professional.” (In the interest of clarity, we use the term “arrestee” to refer to a person who has not had a Gerstein hearing; we use the term “pre-trial detainee” to refer to someone who has had a Gerstein hearing or its equivalent.) The fact that the defendants operate under a contract with the County is immaterial here, since they concede that they “provid[ed] their medical services under a government contract fulfilling a governmental function.” See West v. Atkins, 487 U.S. 42, 108 S.Ct. 2250, 101 L.Ed.2d 40 (1988) (delivery of medical treatment to prisoner by part-time contract physician qualifies as state action for purposes of 42 U.S.C. § 1983). The defendants' real argument is that the Fourth Amendment never governs constitutional claims alleging inadequate provision of medical care to an arrestee by a nurse or doctor, regardless of the defendant's employment arrangement.

Although the Supreme Court has provided relatively little guidance regarding the constitutional rights of arrestees and pretrial detainees, see Graham v. Connor, 490 U.S. 386, 395 n. 10, 109 S.Ct. 1865, 104 L.Ed.2d 443 (1989) (noting, without deciding, the question whether Fourth Amendment protections extend through the period of pretrial detention), this court's cases foreclose the defendants' argument. In Villanova v. Abrams, we held that “the Fourth Amendment governs the period of confinement between arrest without a warrant and the [probable cause determination],” 972 F.2d 792, 797 (7th Cir.1992), and we have since applied the Fourth Amendment's “objectively unreasonable” standard to both “conditions of confinement” and “medical care” claims brought by arrestees who have...