Ninth Circuit: Error to Instruct Jury to Defer to Medical Staff’s Asserted Security Justification for Terminating California Prisoner’s Morphine Prescription Without Tapering
by Matt Clarke
On September 15, 2021, the U.S. Court of Appeals for the Ninth Circuit ruled that a federal district court in California erred when it instructed the jury in a prisoner’s civil rights trial to defer to prison medical staff’s “security justification” for stopping his morphine medication abruptly—without tapering the dosage—leaving him to experience withdrawal symptoms.
The long-running case traces to 2008, when a stash of 50 morphine pills was found in Daniel Murphy Coston’s cell at California State Prison in Sacramento. Prison policy required the drug’s delivery under “Direct Observation Therapy” (DOT), meaning both a nurse and an escorting guard must observe the prisoner take the medication. That had not happened, though.
Yet Dr. Andrew Nangalama decided Coston was hoarding morphine and the prescription must be cancelled, without tapering the dosage and without evaluating the prisoner beforehand. He also didn’t examine Coston afterward for some four months.
Coston had been prescribed morphine for a degenerative joint disease that causes chronic pain in his back, foot and left shoulder. Eleven days after it was cancelled, a nurse found Coston on the floor of his cell, heavily perspiring, with vomit near his head.
He was taken to the prison emergency room, where his increased blood pressure, nausea, and vomiting—all symptoms of morphine withdrawal—were noted. Over the next few months, Coston complained of severe, debilitating pain.
In 2010, he filed suit pro se in U.S. District Court for the Eastern District of California under 42 U.S.C. § 1983, accusing Nangalama and nurse Ronald Hale of deliberate indifference to his serious medical needs in violation of his Eighth Amendment guarantee to freedom from cruel and unusual punishment.
The district court granted a directed verdict for Defendants, and Coston appealed. The Ninth Circuit, finding the district court had made a procedural error, vacated the verdict and remanded the case. See: Coston v. Nangalama, 669 F. App’x 371 (9th Cir. 2016).
Back at the district court, the jury was instructed to defer to Defendants’ security justification for Nangalama’s actions, after which a verdict was returned in their favor. Coston again appealed.
Taking up the case once more, the Ninth Circuit admitted that it was unique among the circuits in having a security-deference instruction like the one given the jury. However, as decided in Chess v. Dovey, 790 F.3d 961 (9th Cir. 2015), and also properly raised pro se by Coston in a trial objection, any defendant seeking such a jury charge must show a plausible connection between a security-based policy or practice and the challenged decision.
The Court noted Nangalama’s testimony that he was concerned another prisoner might take hoarded medication but that his decision to cancel the prescription without tapering the dosage was based on his belief that Coston had not been taking it.
Yet none of the pills was “degraded” as they would be after time in someone’s mouth. The Court also noted that two guards testified Hale often left morphine pills in a prisoner’s cell if the prisoner was absent for recreation when the nurse came by to dispense medication, in violation of the DOT policy.
Thus, the Court held, Defendants had not shown a plausible connection because, had they simply followed policy, Coston could not have hoarded pills. “This fact breaks any plausible connection between a security-based policy or practice and the medical decision” to terminate Coston’s morphine prescription without tapering, the Court continued, concluding that “[s]ince such an instruction deals a ‘devastating blow’ to the plaintiff’s constitutional claims,” it cannot be considered harmless.
The district court’s judgment was therefore reversed and the case remanded for retrial. On this appeal, Coston was represented by attorney Aaron Littman and certified law students Alberto de Diego Carreas and Amaris Montes of the UCLA School of Law Prisoners’ Rights Clinic, along with Burbank attorneys Emily V. Cuatto and Barry P. Levy of Horvitz & Levy and Pasadena attorney Catlin S. Weisberg of Kaye McLane Bednarski & Litt. See: Coston v. Nangalama, 13 F.4th 729 (9th Cir. 2021).
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