Johnson and Bell
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Fall 2011



Gabriel R. Judd

The courts have long held that “when the State takes a person into its custody and holds [him or her] there against [his or her] will, the Constitution imposes upon it a corresponding duty to assume some responsibility for [his or her] safety and general well-being.”  DeShaney v. Winnebago Cnty. Dep’t of Soc. Serv., 489 U.S. 189, 199-200 (1989).  State actors who encounter a detainee are constitutionally obligated to reasonably respond to his or her medical complaints. Failure to do so may result in both the municipality and individual employee being held civilly liable regardless of how long the arrestee was detained.

In Ortiz v. City of Chicago, the Seventh Circuit reversed, in part, the district court’s grant of summary judgment for the defendants with respect to defendants’ denial of plaintiff’s medical care claim. Applying the Fourth Amendment’s reasonableness standard, the appeals court held that the plaintiff, decedent’s daughter April Ortiz, sufficiently showed: (1) each individual defendant officer was on notice of the decedent’s medical condition; (2) her medical needs were serious in nature; and (3) their failure to act caused her harm, in order to survive summary judgment. 2011 U.S. App. LEXIS 17759 (7th Cir. August 25, 2011).

The decedent, May Molina, was a prominent civil rights activist well-known for protesting against the Chicago Police Department. Molina was disabled, obese, and in overall poor health. At the time of her arrest Molina was taking medications daily for Type II diabetes mellitus, thyroid condition, hypertension, and asthma.  She required constant access to her medications and monitoring of her blood sugar levels in order to stay alive. Notably, Molina informed her arresting officers and initial booking officers of her serious medical conditions, which were further reflected in her arrest reports and screening records.    

After her arrest, Molina was temporarily detained at the 23rd District lockup, which did not have a women’s unit.  At that time, Molina’s daughter Ortiz, arrived at the station with her mother’s medications and explained to the officer on duty (who was not named in the lawsuit) that her mother needed the medications in order to “save her life.” Due to a CPD policy, which prevents detainees from bringing their medications to lockup, the officer refused to accept Molina’s medications but assured Ortiz that Molina would be taken to the hospital shortly. 

Molina was eventually transported to the 19th District lockup. Upon being processed, Molina informed two of the defendant officers that she suffered from “serious medical problems.” Molina’s screening records indicated that she was taking medicine for diabetes, thyroid-related issues, and other conditions. Notwithstanding, one of the defendant officers testified that after fingerprinting Molina, she stated that she was fine and did not want to go to the hospital.

While in the 19th District lockup, a fellow inmate testified that she heard Molina yell several times for a doctor and a wheelchair. The woman also testified that during this same time the defendant officers failed to conduct their requisite 15-minute cell checks.

After being detained for about 16 hours, Molina was visited by her attorney who immediately stopped their meeting short after seeing that Molina was visibly groggy, exhausted, and incapable of standing on her own. The attorney testified at his deposition that he informed the on duty defendant officers that his client was in poor physical health and needed immediate medical attention. One of the defendant officers claimed she was not present during this time while the other officer denied that this exchange with Molina’s attorney ever occurred.

After Molina’s attorney left, the defendant officer at the front desk received approximately five to ten telephone calls from various people informing her that Molina needed to take her medications or go see a doctor. Rather than check on Molina, the officer informed the callers that a request for medication must come from the detainee and not a third party. Then the officer informed her supervisors of the calls. Again, there was no responsive action taken by the defendant officers.

Almost 20 hours after her initial arrest, another inmate testified that she heard Molina yell for medical attention. This inmate testified that she heard Molina ask the guards for her medications, a walker and a telephone call. According to her, the guards simply ignored Molina’s requests. Eventually the inmate yelled on Molina’s behalf, to which the guards responded “shut the f—up!”  Again, an inmate witness testified that the guards failed to conduct their required 15-minute cell checks.

Just over 27 hours after her initial arrest, Molina was found dead in her cell. During Molina’s post-mortem examination, the Cook County Medical Examiner determined that Molina ingested six tinfoil packets before her demise. Toxicology reports showed that Molina had morphine in her blood at the time of death. The Examiner concluded that Molina died from opiate intoxication complicated by obesity and cirrhosis of the liver.

Fourth Amendment Reasonableness Standard

Courts apply two different standards when dealing with the constitutional assessment of an arrestee’s medical needs. Unlike the Eighth Amendment’s deliberate indifference standard, which applies to post-conviction claims, claims brought by detainees awaiting a judicial determination of probable cause or trial are assessed by virtue of the Fourth Amendment’s Due Process Clause.

Four factors are used under the Fourth Amendment’s reasonableness standard in order to determine whether an officer’s response to an arrestee’s medical needs was objectively unreasonable. These factors are: (1) whether the officer has notice of the detainee’s medical needs; (2) the seriousness of the medical need; (3) the scope of the requested treatment; and (4) police interests, including administrative, penological or investigatory concerns. Due to varying scenarios, this analysis operates on a sliding scale, balancing the seriousness of the medical need with the scope of the requested treatment.

Here, the defendants did not assert that taking Molina to the hospital would have been burdensome or compromise any police interests. As the issues before the court in Ortiz were whether each defendant officer was on notice of Molina’s condition, the seriousness of Molina's medical needs, and whether their failure to act caused her harm. While the court agreed with defendants’ general proposition that lockup keepers should not be required to transport arrestees to the hospital every time there is a complaint, the court went on to state “[t]his general proposition … is not a license for lockup keepers to deny all arrestees all medical care simply because they will probably be transferred within 48 hours … a detainee cannot be treated like a hot potato, to be passed along as quickly as possible to the next holder.”

In reversing the district court’s grant of summary judgment, the Seventh Circuit held that a jury could find, based on what the defendants knew at the time, that their failure to take action and seek medical care for Molina was objectively unreasonable. The appeals court highlighted several instances where there was sufficient notice that would reasonably require an officer to take action (i.e. Molina’s screening record indicating that she required medications daily and suffered from serious medical problem; (2) requests by Molina for her medications and medical assistance; (3) comments from Molina’s attorney that she was in poor physical condition and needed medical attention; (4) phone calls from third parties stating that Molina needed her medications and/or to be taken to a hospital; and (5) statements by other inmates requesting medical attention on Molina’s behalf.  All of these disputed facts, taken in a light most favorable to the plaintiff, were held to be clearly sufficient to survive summary judgment.

Causation Analysis

The Seventh Circuit also held that the district court failed to apply the proper causation inquiry.  According to the Seventh Circuit, the proper inquiry was whether the plaintiff failed to present sufficient evidence to permit a jury to infer that the defendants’ failure to act was a source of harm for Molina. In contrast, the district court applied a much narrower inquiry asking whether the plaintiff could prove that the failure of the defendants to provide Molina with access to her medications proximately caused her death.

As framed, the district court mistakenly focused on the admissibility of testimony from the plaintiff’s expert, which it ultimately excluded. The Seventh Circuit held that the district court abused its discretion in excluding the plaintiffs’ expert’s testimony.  Moreover, the court held that only in rare instances should summary judgment be granted on the issue of causation. Here, where an obviously ill detainee dies in custody and there is a challenge as to whether the defendants failed to provide medical care, the causation inquiry should be broadened not narrowed.  According to the Seventh Circuitt, the constitutional violation at issue is the failure to provide adequate medical care in response to a serious medical condition, not causing her death. As such, the court held that based on the medical records and witnesses’ testimony, a jury could infer that the defendants caused Molina harm when they failed to take her to the hospital after they knew she suffered from a serious medical condition, and were arguably on notice that Molina required medical attention.

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