Katie Stancombe for www.theindianalawyer.com

Case law does not clearly establish that a paramedic can violate a patient-arrestee’s Fourth Amendment rights by exercising medical judgment to administer a sedative in a medical emergency, the 7^th Circuit Court of Appeals affirmed Wednesday.

Following a naked public rampage while high on amphetamines, Dusty Heishman’s heart stopped after a paramedic administered a sedative in order to detain him.

On an October night in 2014, paramedic Lance Cope was informed by an officer that he needed to “take a look” at Heishman, who “was being combative.” Cope had been called to the scene in response to a report of an animal bite, but he discovered it was a human bite made by Heishman.

When Cope arrived, Heishman was naked and lying prone in the middle of the street. His hands were cuffed behind his back and his ankles were shackled together after fighting and struggling against the several officers who restrained him.

After an assessment, Cope injected Heishman with a sedative, Versed, as a “chemical restraint for patient and crew safety,” and watched his breathing. The darkness made it difficult for Cope to make an assessment, and upon entering the ambulance, Cope saw that Heishman was not breathing and found he had no pulse. Seven minutes of CPR restored Heishman’s heartbeat and breathing, but he remained unconscious. Heishman lost brain function and died eight days later.

Heishman’s estate sued Cope, the Health and Hospital Corporation of Marion County, and other defendants, asserting federal Fourth Amendment and state-law tort claims. The estate brought claims against Cope in his individual and official capacities for excessive force, deliberate indifference, and failure to protect/intervene.

The estate also brought six state-law claims against Cope, the hospital, or both including wrongful death; damages resulting from injuries sustained before Heishman’s death; intentional infliction of emotional distress; negligent infliction of emotional distress; negligence and battery.

Cope and the hospital moved to dismiss the state-law claims for what they called lack of subject-matter jurisdiction, arguing that Indiana’s Medical Malpractice Act required the estate to take those claims before a medical review panel before filing suit. The district court dismissed the wrongful death claim against the hospital but denied the motion with respect to the other state-law claims.

Cope then moved for summary judgment on the federal constitutional claims. The district court granted the motion on the official-capacity claims and the claims against Cope for deliberate indifference and failure to protect/intervene but denied it on the excessive force claim against Cope in his individual capacity.

The 7^th Circuit reversed that denial on appeal, finding Cope entitled to qualified immunity on the excessive force claim. It also found that all six state-law claims were subject to the substantive terms of Indiana’s Medical Malpractice Act, including damage caps and the requirement to submit the claim to a medical review panel before suit is filed.

It also found that the district court tried to “to treat this case as an obvious one, evident from broad principles in excessive force cases.” The 7^th Circuit concluded that a paramedic would not be reasonably familiar with Circuit and Supreme Court precedent or would have understood that the Fourth Amendment prohibition of unreasonable searches and seizures applies to treatment in the field during a medical emergency.

Neither the estate nor the district court cited cases where a court found that conduct like Cope’s — administering a therapeutic drug in response to a medical emergency —violated the Fourth Amendment, the 7^th Circuit continued. Cases cited by the plaintiff and district court involved excessive force cases brought against police officers, not medical professionals.

“To treat the right as clearly established, the district court boiled away key circumstances of the situation here — especially the fact that Cope was a paramedic confronting a patient suffering from a life-threatening emergency,” Judge David Hamilton wrote. “Those facts take this case out of the realm of clearly established Fourth Amendment law.”

Finally, the 7^th Circuit affirmed that the estate’s state-law claims must be dismissed without prejudice, are subject to the Indiana Medical Malpractice Act and must be presented to a medical review panel under the Act before the plaintiff estate may proceed in court.

It concluded that the facts of the circumstances “fit comfortably” within the broad statutory definitions of the Act.

“Instead, the estate’s arguments — about whether Cope gave the right dosage of the sedative or negligently failed to monitor Heishman or changed his prone position — sound in malpractice,” Hamilton concluded. “To resolve those issues, a judge or jury will need to evaluate Cope’s actions in terms of medical standards of care. The accompanying claims for emotional distress are also subject to the Act because they result from the alleged malpractice.”

The 7^th Circuit reversed the denial of Cope’s motion for summary judgment on the excessive force claim and the denial of defendants’ motion to dismiss the state-law claims, remanding Billie Thompson v. Lance Cope, 17-3060, with instructions to dismiss the estate’s state law claims without prejudice and to dismiss the federal claims against Cope with prejudice.