Buckley v. Hennepin Cnty.

• Citation: 9 F.4th 757
• Decision Date: 16 August 2021
• Docket Number: No. 19-3243,19-3243
• Parties: Brittany J. BUCKLEY, Plaintiff - Appellant v. HENNEPIN COUNTY, et al., Defendants - Appellees
• Court: U.S. Court of Appeals — Eighth Circuit

9 F.4th 757

Brittany J. BUCKLEY, Plaintiff - Appellant

v.HENNEPIN COUNTY, et al., Defendants - Appellees

No. 19-3243

United States Court of Appeals, Eighth Circuit.

Submitted: October 22, 2020

Filed: August 16, 2021

Zorislav Romanovich Leyderman, LAW OFFICE OF ZORISLAV R. LEYDERMAN, Minneapolis, MN, for Plaintiff - Appellant.

Matthew S. Frantzen, Henry Adams Parkhurst, HENNEPIN COUNTY ATTORNEY'S OFFICE, Government Center, Civil Division, Minneapolis, MN, for Defendants - Appellees.

Henry Adams Parkhurst, HENNEPIN COUNTY ATTORNEY'S OFFICE, Government Center, Civil Division, Minneapolis, MN, for Defendant - Appellee Researchers J. Does 1-10.

Before SMITH, Chief Judge, LOKEN and GRUENDER, Circuit Judges.

LOKEN, Circuit Judge.

In December 2017, depressed about her father's death, Brittany Buckley had been drinking for two days and threatened self-harm. A friend called 911 to request a welfare check and let police officers into Buckley's apartment when they arrived. The officers spoke with Buckley and called an ambulance. Paramedics Anthony D'Agostino, Katherine Kaufmann, and Johnathan Thomalia arrived, conversed briefly with Buckley, and determined she needed to go to the hospital. Buckley objected; the paramedics advised she was on a medical transportation hold. When Buckley continued objecting, the officers and paramedics handcuffed her and carried her to the ambulance, where she was placed on a gurney and secured by cuffing each arm to a rail, with a shoulder harness, and hip, thigh, and ankle straps. The paramedics decided to inject her with a sedative. Buckley objected to being injected with an unknown medication, to no avail. The commonly used sedative was ketamine. Buckley immediately developed serious respiratory distress. The paramedics manually ventilated her, administered atropine, and used suction to remove excess saliva. At the Hennepin County Medical Center, Buckley was diagnosed with acute hypoxia (low oxygen) respiratory failure, a known complication of ketamine, and was promptly intubated into the following day. This lawsuit followed.

A major focus of Buckley's Complaint and her briefs on appeal is Hennepin County's so-called "ketamine trials," two studies the County conducted on the use of ketamine as a pre-hospital sedative for agitated patients. Buckley asserts 42 U.S.C. § 1983 compensatory and punitive damage claims against paramedics D'Agostino, Kaufmann, and Thomalia for injecting her with ketamine without her consent, and against physicians who allegedly implemented ambulance protocols while conducting the second study, both in their individual and official capacities. She also asserts claims of Monell liability¹ against Hennepin County, several of its health care facilities, and the individual defendants for developing and implementing a county-wide ketamine protocol. Buckley's Complaint alleged that defendants used excessive force, violated her right to bodily integrity, and acted with deliberate indifference in violation of the Fourth Amendment and her right to substantive due process under the Fourteenth Amendment.

The district court² granted defendants’ motion for judgment on the pleadings, see Fed. R. Civ. P. 12(c), dismissing Buckley's federal § 1983 claims with prejudice and declining to exercise supplemental jurisdiction over her pendent state law claims. The court concluded: (i) "the paramedics’ decision to inject Buckley with ketamine while responding to a medical emergency did not violate Buckley's right to be free from excessive force under the Fourth Amendment," (ii) "Buckley fails to allege a violation of her substantive due process right to bodily integrity," (iii) "Buckley also fails to allege a violation of her substantive due process rights premised on Defendants’ [medical] deliberate indifference," (iv) alternatively, the paramedics are entitled to qualified immunity, (v) the physician defendants are entitled to qualified immunity "because the Court has seen no evidence that designing, implementing, and overseeing the ketamine studies violated a clearly established right," and (vi) the claims of Monell liability fail because "the complaint and documents embraced by the complaint do not plausibly allege that the individual Defendants violated Buckley's constitutionally protected rights." Buckley v. Hennepin Cnty. et al., No. 18-cv-3124, Memorandum (D. Mn. Sep. 11, 2019).

Buckley appeals the dismissal of her federal claims. Our standard reviewing a Rule 12(c) judgment on the pleadings is the same as a Rule 12(b)(6) dismissal. Westcott v. City of Omaha, 901 F.2d 1486, 1488 (8th Cir. 1990). We review whether the complaint states a cause of action de novo . Id. We construe the Complaint in favor of Buckley, the non-moving party, assuming well-pleaded facts are true, but we do not accept legal conclusions phrased as fact allegations. Ashcroft v. Iqbal, 556 U.S. 662, 678, 129 S.Ct. 1937, 173 L.Ed.2d 868 (2009). A claim must be plausible on its face to survive dismissal. Id. We may rely on materials "necessarily embraced by the pleadings," including exhibits attached to the complaint and matters of public record.

Greenman v. Jessen, 787 F.3d 882, 887 (8th Cir. 2015). Neither party challenges on appeal the district court's consideration of numerous materials as embraced by the pleadings. Reviewing dismissal of the federal claims under these standards, we affirm.

I. Claims Against the Paramedics.

A. Excessive Force Claims. On appeal, Buckley first argues her Complaint sufficiently states a "Fourteenth Amendment excessive force claim" against the paramedics. In the district court, she argued the paramedics used excessive force violating the Fourth and the Fourteenth Amendment. The district court agreed with defendants that the Fourth Amendment "objective reasonableness" standard should apply. See Graham v. Connor, 490 U.S. 386, 394-399, 109 S.Ct. 1865, 104 L.Ed.2d 443 (1989). Buckley concedes she was properly placed on a medical transport hold and secured on the ambulance gurney, actions that effectuated a Fourth Amendment seizure. See Green v. City of New York, 465 F.3d 65, 83 (2d Cir. 2006). The paramedics then allegedly used excessive force when they sedated her with ketamine without her consent while she was fully restrained.

The paramedics were acting as medical responders, not as law enforcement officers, when they sedated Buckley after she had been seized and was being transported to a hospital. State law authorized the paramedics to "take a person into custody and transport the person to a licenced physician or treatment facility if the officer has reason to believe ... that the person is mentally ill ... and in danger of injuring self or others if not immediately detained." Minn. Stat. § 253B.05, subd. 2(a) (2019).³ Buckley does not dispute the legitimacy of the medical hold. Hennepin County's Emergency Medical Services Advanced Life Support protocols provided that "[a]ll patients transported on a Transport Hold should be restrained during transport" and a patient who is severely or profoundly agitated should be sedated.

In two quite similar cases where paramedics administered emergency medical treatment either after seizure or to a person who did not object to seizure, our sister circuits reversed the denial of qualified immunity and dismissed Fourth Amendment excessive force claims. In Peete v. Nashville and Davidson County, paramedics physically restrained an unconscious boy who had experienced an epileptic seizure without ensuring he could breathe, resulting in his death. 486 F.3d 217, 220 (6th Cir. 2007), cert. denied, 553 U.S. 1032, 128 S.Ct. 2466, 171 L.Ed.2d 230 (2008). The Sixth Circuit concluded the paramedics

were not acting to enforce the law, deter, or incarcerate. ... They were attempting to help him, although they badly botched the job according to the complaint. ... The plaintiff's excessive force claim thus looks like a medical malpractice claim rather than a Fourth Amendment or Due Process violation.

Id. at 222. In Thompson v. Cope, 900 F.3d 414 (7th Cir. 2018), the Seventh Circuit reversed the denial of qualified immunity and dismissed Fourth Amendment claims against paramedics who administered a sedative to a mentally disturbed person whom police had restrained and arrested. The court observed that "Fourth Amendment restrictions are almost wholly alien to [a] situation, where paramedics are subject to a distinct set of professional standards and goals aimed at responding to medical emergencies." Id. at 423. "[S]edating the arrestee -- who appear[ed] to the paramedic to be suffering from a medical emergency -- before taking the arrestee by ambulance to the hospital" did not violate the arrestee's clearly established Fourth Amendment rights. Id. at 422. Otherwise, the court observed, paramedics would face a "kind of Catch-22 ... treat the arrestee or don't treat him, but face a lawsuit either way." Id. at 423. We agree with these decisions.

The courts in these cases considered excessive force claims pleaded under the Fourth Amendment and applied its well-established objective reasonableness standard, as the district court did in this case. On appeal, Buckley argues her status was akin to that of the involuntarily committed patient in Andrews v. Neer, 253 F.3d 1052 (8th Cir. 2001), and therefore her excessive force claim "should be analyzed under the Fourteenth Amendment pretrial-detainee objective reasonableness standard." We see this as a distinction without a difference. Under either standard, "liability for negligently inflicted harms is categorically beneath the threshold of constitutional due process." Kingsley v. Hendrickson, 576 U.S. 389, 396, 135 S.Ct. 2466, 192 L.Ed.2d 416 (2015) (quotation omitted; emphasis in original).

Buckley concedes that her suicidal and intoxicated state made it necessary for paramedics to place her on a medical hold and transport her to the hospital because she was a danger to herself. But she contends that she was not...