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Second Circuit: Discharge Health Plan Part of In-Custody Mental Health Treatment When Pretrial Detainees Released

by Ed Lyon

In what it called “a legal question of first impression” within its jurisdiction, on May 24, 2019 the Second Circuit Court of Appeals ruled that the lack of a discharge plan to obtain medication and treatment for mental health care after a detainee is released from custody “can be considered a claim to in-custody care cognizable under the ‘special relationship exception.’”

Plaintiff-appellants Michelet Charles and Carol Small are lawful U.S. residents. Both were detained by Immigration and Customs Enforcement (ICE) for immigration hearings and held in jail for several months in Orange County, New York as civil detainees. Charles had a history of mental illness that was managed by drugs, while Small’s mental health condition manifested while she was in custody.

Both were treated with psychotropic medication and monitored by medical staff and psychiatrists during their detention. Once released immediately after their immigration hearings, they were not provided with an interim supply of their prescribed medications, nor did they receive a discharge summary with which they could obtain a continuation of treatment and drugs from a new mental health care provider. While a discharge summary was prepared for each of them, it remained in their records.

After their abrupt release from custody, both Charles and Small suffered remanifestations of their mental illness. Charles became so unmanageable that his family had to summon police, who took him to a hospital for commitment and inpatient treatment to stabilize him. Small realized what was beginning to happen to her and sought treatment at a hospital emergency room. There she obtained the proper psychotropic drugs to stabilize her condition.

The pair sued Orange County and several defendants for deliberate indifference to their serious medical needs. The district court dismissed the case, erroneously holding that since Charles and Small were no longer in custody following their release, the defendants had no duty to provide discharge summaries or medications for an interim period so they could secure treatment and medications from another provider.

The Second Circuit noted the U.S. Supreme Court’s decision in Estelle v. Gamble, 429 U.S. 97 (1976) imposed an obligation to provide necessary medical care to prisoners. That obligation was extended to pretrial detainees in Youngberg v. Romeo, 457 U.S. 307 (1982). Following that decision was the Supreme Court’s “special relationship exception” that imposes an affirmative duty to provide for a prisoner’s “safety and general well-being” due to “the limitation which [the state] has imposed on [the person’s] freedom to act on his own behalf.” See: In DeShaney v. Winnebago Cty. Dep’t of Soc. Servs., 489 U.S. 189 (1989).

“Plaintiffs have plausibly alleged that Defendants were fully aware of, and violated, both Orange County and ICE policies by failing to provide them with discharge planning as part of their care,” the Court of Appeals wrote. “Plaintiffs’ allegations, if proven true, are sufficient to establish that Defendants knew, or should have known, of the substantial risk that Plaintiffs would relapse and suffer serious adverse health consequences if they were not provided with necessary discharge planning, such that a fact-finder could infer ‘reckless disregard’ beyond mere negligence or medical malpractice.”

Accordingly, the district court’s order was vacated and the case remanded for further proceedings. See: Charles v. Orange Cty., 925 F.3d 73 (2d Cir. 2019). 

Related legal cases

Charles v. Orange Cty.

In DeShaney v. Winnebago Cty. Dep’t of Soc. Servs.