In Miranda v. Cty. of Lake, 900 F.3d 335 (7th Cir. 2018), the Seventh Circuit held that denial of medical treatment claims by pretrial detainees are no longer subject to the deliberate indifference standard but are to be analyzed under an objective reasonableness standard.  This dramatic shift follows similar decisions by the Second and Ninth Circuit Courts of Appeals.

Decedent Lyvita Gomes was initially arrested on October 12, 2011 for failure to appear for jury duty and resisting arresting.  After failing to appear for her court date, she was arrested for a second time and sent to Lake County Jail on December 14, 2011.  Gomes was placed in general population and received a mental health evaluation two days later.  After it was noted that she had not eaten or had anything to drink since her arrival, Gomes was placed in medical housing and later on suicide watch.  At that point, she had already gone without food or drink for four days and weighed 146 pounds.  Ten days later, she was 128 pounds.  During this period, Gomes was monitored by medical staff and seen by an internist twice.  Due to her unresponsiveness to questioning and refusal to eat or drink, medical personnel could not take her vital signs or take blood or urine samples.

Gomes was ordered to undergo a mental fitness exam.  She was seen by a psychiatrist who diagnosed her with a “psychotic disorder not otherwise specified”, but was not prescribed any medication.  The psychiatrist determined Gomes could not understand the risks of not eating or drinking.  However, he did not support another doctor’s plan to involuntarily draw blood samples for monitoring, saying that this could occur only if push came to shove.  Jail officials were notified that Gomes was refusing medical treatment and testing.  Officials were informed that medical staff were monitoring Gomes and would provide updates.  On December 29, 2011, Gomes was sent by ambulance to the hospital.  However, she died of complications from starvation and dehydration on January 3, 2012 with the cause of death determined to be suicide.

Gomes’ Estate sued the County, jail officials, and medical and mental health providers for denial of medical treatment in violation of the Fourteenth Amendment.  Following a trial against the medical defendants, the Estate challenged the district court’s jury instruction as to intent.

The Seventh Circuit began its discussion by reviewing the Eighth Amendment’s “deliberate indifference” standard for denial of medical treatment as stated in Estelle v. Gamble, 429 U.S. 97 (1976).  Under Estelle, plaintiffs must demonstrate the defendant had a “sufficiently culpable state of mind”, i.e., the official subjectively believed there was a significant risk of harm to the prisoner.  Unlike convicted prisoners, whose treatment is governed by the Eight Amendment’s prohibition against cruel and unusual punishment, pretrial detainees may not be punished at all as stated in Bell v. Wolfish, 441 U.S. 520 (1979).  Although the Due Process Clause of the Fourteenth Amendment governs the rights of detainees, courts have historically borrowed the Eighth Amendment’s deliberate indifference standard when deciding claims involving detainee treatment.

The Court of Appeals then turned to the Supreme Court’s decision in Kingsley v. Hendrickson, 135 S. Ct. 2466, 192 L. Ed. 2d 416 (2015), which held that a detainee bringing an excessive force claim did not need to prove the defendant was subjectively aware that the amount of force being used was unreasonable.  Instead, the plaintiff was only required to show the official’s acts were objectively unreasonable.  While the Fifth, Eighth, and Eleventh Circuits limited Kingsley to excessive force claims, the Seventh Circuit chose to follow the Ninth Circuit (Gordon v. Cnty. of Orange, 888 F.3d 1118 (9th Cir. 2018)) and the Second Circuit (Bruno v. City of Schenectady, 727 Fed. App’x. 717 (2d Cir. 2018)) which extended the Kingsley objective reasonableness standard to denial of medical treatment claims by pretrial detainees.

Addressing the defendant medical providers’ argument that the objective reasonableness standard would constitutionalize medical malpractice claims, the Court stated that negligence would continue to fall below the state of mind requirement to raise a constitutional claim.  When assessing a defendant’s state of mind, the Seventh Circuit directed lower courts to first “ask[] whether the medical defendants acted purposefully, knowingly, or perhaps even recklessly when they considered the consequences of their” actions.  Negligence or even gross negligence would not suffice.  With the first question answered, courts must then determine whether the defendant’s actions were reasonable.

This case represents a disturbing trend which could significantly raise the bar for defendants in denial of medical treatment claims.  Although the Court of Appeals argued that the new standard would not constitutionalize negligence claims, it is difficult to predict whether district courts will be able to effectively sort mere medical malpractice claims from Fourteenth Amendment claims, at least on a Rule 12(b)(6) motion to dismiss.  Based on this decision, other conditions of confinement claims may also see subjected to the more stringent objective reasonableness standard in the future.  With a readily apparent circuit split, this issue will very likely be heard by the Supreme Court in the next few years.