The opinion of the court was delivered by: GREEN
This matter is before the Court on plaintiff's motion for summary judgment and defendants' motion to dismiss or for summary judgment. Plaintiff charges that while she was an inmate at the District of Columbia Detention Facility (the D.C. Jail) defendants forcibly injected her with a psychotropic drug, against her will and despite the fact that she refused all medical treatment on the ground that she is a Christian Scientist and adheres to the tenets of that faith which, she asserts, require her to reject the use of medical and psychiatric science in the healing process. She alleges that as a result various of her constitutional rights have been violated, and seeks compensatory and punitive damages therefor pursuant to 42 U.S.C. § 1983. She also charges defendants with assault and battery under the law of the District of Columbia, for which she also seeks compensatory and punitive damages.
For the reasons which follow, three counts of the complaint are dismissed, the complaint is dismissed as to one defendant sued in his individual capacity (but allowed to stand against him in his official capacity), the complaint is dismissed as to defendant District of Columbia, and summary judgment is denied to both plaintiff and defendants. In providing some examples as to disputes of material facts which preclude entry of summary judgment for either side, this Memorandum Opinion does not purport to address all potential issues that may be raised at trial. Rather, it simply demonstrates by way of example why summary judgment is inappropriate.
While the parties dispute certain facts, there is no controversy as to the following matters (except as noted). Plaintiff was in custody as a patient at St. Elizabeths Hospital from November 28, 1979 to April 1, 1980. She has a history of several previous psychiatric hospitalizations and three suicide attempts. She was incarcerated at the D.C. Jail from April 1, 1980 until July 7, 1980, and again from October 10, 1980 until November 18, 1980. She was sentenced on October 16, 1980 for her conviction on a charge of assaulting a federal officer (arising from her having gone to the congressional office of Senator Edward M. Kennedy with a knife), after a jury trial. On April 1, 1980, plaintiff informed jail personnel that she refused, on the basis of her Christian Science beliefs, to receive medical or psychiatric treatment or examination. She signed a form document noting her refusal of "any and all Medical Treatment, and/or tests, prescribed by the Physicians of the Detention Services and/or the Physicians of the D.C. General Hospital." Def. Exh. A. That form bore a handwritten notation to the effect that she refused to provide any medical history data or submit to a physical examination "stating she is a Christian Scientist." Id. A form labeled "Physical Examination" and dated April 4, 1980 was not completed but carried the statement of an examining doctor that "This inmate is very belligerent and threatens me to not come near her. No exam performed." Def. Exh. B. See also Def. Exh. C ("Consultation Sheet," noting her refusal to attend a screening clinic).
During the entirety of plaintiff's stay at the D.C. Jail, except for the afternoon of June 4, 1980, her refusal to submit to medical treatment or examination was honored. According to defendant, this was even though she demonstrated what defendants referred to as "abnormal behavior" as early as April 4, 1980. Def. Exhs. B, C, D (Declaration of defendant Francis Smith, M.D.); Smith Aff. at 18. On that afternoon, she was forcibly injected with the antipsychotic or psychotropic drug Haldol, against her will.
Plaintiff has not directly challenged defendants' description of the events leading to her injection with Haldol that day. According to defendants, earlier that day a psychiatric nurse named David Avery (who had been familiar with plaintiff's behavior since as early as April 4, 1980, see Exh. C) determined that her condition warranted evaluation by a psychiatrist from the Forensic Psychiatry Office "ASAP." Def. Exh. E. He made a record of his observations noting that she was "withdrawn," not communicative, "verbally abusive (cursing and calling other names)," and that she was wearing a blindfold and sleeping under her bed. Id. Plaintiff admits that she had a scarf covering her eyes and was sleeping under her bed to "avoid the lights" because her eyes "are very sensitive to light." Plaintiff's Answers to Interrogatories Nos. 24, 27. She also admits that she screamed once and banged her chair once, but asserts that such behavior was common among inmates. Complaint para. 16. Defendant Francis Smith, M.D., the Chief Medical Officer at the D.C. Jail, upon being advised of plaintiff's condition, requested an evaluation by the Forensic Psychiatry Office.
Plaintiff was then examined by Norman L. Wilson, M.D., a forensic psychiatrist who knew of plaintiff's prior bizarre behavior and also of her alleged visit to Senator Kennedy's office with a knife. Def. Exh. F (Wilson Declaration). He stated that when he saw her she was screaming insults and threatened that she would kill him and the staff members present if she could. Id. (Plaintiff denies that she ever threatened to kill anyone that day, but admits screaming verbal insults at Dr. Wilson and threatening to sue him and the staff members present for violating her constitutional rights. Osgood Aff. para. 2) It was Dr. Wilson's opinion that she was "delusional and actively psychotic" at the time he saw her that day, that she then "presented a substantial danger to others," and that her case "presented a medical emergency" that warranted a five milligram dose of Haldol. Id. He noted her behavior, i.e., that she "spit on people" and "appear[ed] delusional," in writing and diagnosed her condition as a "probable psychotic illness," for which he prescribed that she be (1) evaluated for commitment to St. Elizabeths, (2) given five milligrams of Haldol by mouth or injection, and (3) be seen again the next day. Id.; Def. Exh. H (Consultation Sheet). Dr. Wilson stated that he recommended that she be administered Haldol even though he was aware she was refusing treatment at the time and that he still would have prescribed the drug even if he had been aware of the refusal of treatment form she signed earlier. Def. Exh. F. He also stated that it was his opinion that plaintiff was not competent to make a rational decision as to whether she should be given antipsychotic medication on that date. Id.
There is no dispute that she thereafter was taken, protesting and struggling, to the jail infirmary. She displayed a Christian Scientist book and screamed out statements to the effect that her religious rights were being violated, pleading for someone to call her attorney. In the infirmary she was strapped to a bed. She then was administered an injection of five milligrams of Haldol upon order of Dr. Smith. According to defendants, Dr. Smith did not direct that she be given the drug until after he had confirmed that Dr. Wilson had made the diagnosis and medical recommendation described above. He noted that he was concerned that without treatment plaintiff could have hurt herself. Def. Exh. J (Smith Report of Jun. 6, 1980). Plaintiff alleges that she suffered great "emotional and physical pain" as well as "great psychological and spiritual pain" as a result of the Haldol injection. In the opinion of the physicians and medical staff who observed the plaintiff, however, her condition improved substantially after she was administered Haldol.
The parties disagree as to precisely when on June 4, 1980 certain of plaintiff's acts took place. Defendants assert that she was spitting on people and behaving abusively before she was seen by a doctor; plaintiff, however, appears to contend that the spitting and abusive behavior began only when she was being taken forcibly to the infirmary. Moreover, plaintiff also denies that she was endangering her own life or the safety of others on June 4, 1980 and asserts that there was no "psychiatric emergency" with respect to her that day. Plaintiff also challenges defendants' position that administering Haldol would have been the only viable means of responding to the alleged psychiatric emergency, and avers that maintaining her in arm and leg restraints would have been an equally effective remedy which would not have infringed her constitutional rights.
I. Plaintiff's Motion for Summary Judgment
Because there is a dispute as to facts material to plaintiff's theory of relief, her motion for summary judgment cannot be granted. Fed. R. Civ. P. 56 (c,d). For example, the constitutional rights she asserts were violated by the forcible administration of Haldol are not absolute, and must give way at least where such action is mandated by a compelling state interest: in this case, the need to protect the safety of others. See Roe v. Wade, 410 U.S. 113, 155-56, 35 L. Ed. 2d 147, 93 S. Ct. 705 (1973); Wisconsin v. Yoder, 406 U.S. 205, 214, 32 L. Ed. 2d 15, 92 S. Ct. 1526 (1972); Rennie v. Klein, 653 F.2d 836, 838 (3d Cir. 1981), (en banc), vacated on other grounds, 458 U.S. 1119, 102 S. Ct. 3506, 73 L. Ed. 2d 1381 (1982); Rogers v. Okin, 634 F.2d 650, 654 (1st Cir. 1980), vacated on other grounds sub nom. Mills v. Rogers, 457 U.S. 291, 102 S. Ct. 2442, 73 L. Ed. 2d 16 (1982). Likewise, the fact of a medical emergency may vitiate any common-law claim for assault or battery arising from unconsented-to medical treatment. See e.g., Dunham v. Wright, 423 F.2d 940, 941-42 (3d Cir. 1970). In the instant case, defendants assert that, contrary to plaintiff's view, the actions taken by them were in response to a medical emergency in which plaintiff presented a danger to others. This dispute alone therefore is sufficient to make summary judgment in favor of plaintiff inappropriate.
A "compelling state interest" will justify actions of the type at issue in the instant case that infringe constitutional rights only where there is no reasonable alternative action that is less intrusive upon those rights. Sherbert v. Verner, 374 U.S. 398, 407, 10 L. Ed. 2d 965, 83 S. Ct. 1790 (1963), Rennie v. Klein, 653 F.2d at 845. Plaintiff asserts that a "less intrusive" means was available to defendants: they could simply have kept her in arm and leg restraints without drugging her. Defendants, however, argue that this method would not have been a reasonable alternative, noting that the restraints used at D.C. Jail are not foolproof and citing examples in the past where inmates were able to free themselves from those restraints, which are of a medically-approved type that the jail is compelled to use as a result of a court order in a previous case. The presence of this factual controversy also renders the Court unable to enter summary judgment for plaintiff.
Moreover, to the extent that plaintiff's claim is founded upon the alleged infringement of her first amendment right to the free exercise of her religion (which right is the focus of count I of her complaint and referenced specifically in counts II, IV, V, VI, and VII and implicitly in count III), a factual dispute precludes entry of summary judgment in that defendants contest whether her refusal of treatment was a result of her rational choice and religious beliefs or a product of "paranoid schizophrenia." Def. Mem. in Support of Def. Mot. at 8 n.2. Accordingly, plaintiff's motion must be denied.
II. Defendants' Motion to Dismiss or for Summary Judgment
Because defendants' motion also seeks dismissal of the complaint for failure to state a claim upon which relief can be granted, the necessity of exploring the threshold issue of the complaint's legal sufficiency means that the motion is not ...