Alapati v. City and County of San Francisco

Background

Alapati alleged that she was held at the City and County of San Francisco’s County Jail 2 and began working in its laundry department in late February 2019. She alleged that laundry items contaminated with feces, vomit, urine, and blood were mixed with other items rather than separately sanitized. She also alleged that she had a preexisting heart condition involving an aortic valve replacement and that jail medical staff knew about it.

Between March 4 and March 13, 2019, Alapati reported worsening symptoms, including swelling, body aches, fatigue, dizziness, low blood pressure, immobility, abnormal temperatures, nosebleeds, nausea, painful urination, and chest pain. She alleged that medical staff repeatedly gave her Tylenol, water, or ice chips without providing more extensive examination, testing, or an earlier hospital transfer. She was eventually taken to a hospital, where doctors diagnosed E. coli and sepsis infections and a compromised heart valve. She later underwent surgery to replace the valve.

Alapati’s second amended complaint asserted 15 causes of action against San Francisco, jail medical personnel, and unidentified defendants. The claims included constitutional claims under 42 U.S.C. § 1983, negligence, emotional-distress claims, assault and battery, municipal liability, claims under California statutes, the Americans with Disabilities Act, the Unruh Civil Rights Act, and the California Disabled Persons Act. The defendants moved to dismiss for failure to state a claim under Federal Rule of Civil Procedure 12(b)(6).

Court’s analysis and rulings

A Rule 12(b)(6) motion tests whether a complaint contains enough factual allegations to support a legally recognized claim. The court accepted the complaint’s factual allegations as true for purposes of deciding the motion, but did not accept bare legal conclusions.

Claims based on laundry conditions and policies. The court dismissed Claims 1 and 2 to the extent they were based on the laundry facility’s conditions. The complaint did not allege that the medical or unidentified defendants were personally involved in operating the laundry facility or assigning Alapati to work there. The medical defendants were dismissed with prejudice from those portions of Claims 1 and 2; the unidentified defendants were dismissed without prejudice; and San Francisco was dismissed without prejudice because the complaint did not allege a municipal policy or custom concerning the laundry conditions.

The court also dismissed without prejudice the portions of Claims 1 and 2 based on the existence or absence of medical policies and procedures. The complaint did not adequately allege personal involvement by the medical or unidentified defendants or show that a San Francisco policy was the moving force behind the alleged constitutional violation.

Medical-care claim. The court concluded that the complaint adequately alleged a Fourteenth Amendment deliberate-indifference claim concerning medical care. It reasoned that the alleged repeated treatment with Tylenol, water, and ice chips, despite Alapati’s known heart condition and worsening symptoms, could support an inference that medical staff failed to take reasonable available measures against a substantial risk of serious harm. The court also inferred that the alleged delays caused the mechanical heart valve to fail.

However, the court found that the complaint did not adequately allege the purposeful conduct required for an Eighth Amendment medical-care claim. Because the complaint did not state whether Alapati was a pretrial detainee or a post-conviction prisoner, the court dismissed all of Claim 3 with leave to amend so she could identify her status and the applicable constitutional standard. The court found sufficient alleged personal involvement for most named medical defendants but noted that the complaint contained no allegations about Nurse Williams.

Bystander liability. The court dismissed Claim 4 against all defendants with leave to amend. The allegation that defendants witnessed constitutional violations and failed to intervene was conclusory and did not show that each defendant was an integral participant who knew about and participated in the allegedly unconstitutional conduct.

Negligence and related tort claims. The court found that Claim 5 adequately alleged negligence, gross negligence, and recklessness against the medical defendants other than Nurse Williams. It dismissed the claim against the unidentified defendants with leave to amend. It dismissed San Francisco with leave to amend because the complaint did not identify a statutory exception to California’s immunity for injuries to prisoners.

The court also concluded that the negligence allegations supported a negligent infliction of emotional distress claim against the medical defendants in Claim 9. The claim could not proceed against San Francisco without an applicable statutory exception to immunity, so San Francisco was dismissed with leave to amend from that claim.

Municipal liability and negligent supervision. The court dismissed Claim 6, the Section 1983 municipal-liability claim against San Francisco, with leave to amend. The complaint did not allege that the asserted training deficiencies were persistent and widespread enough to constitute a permanent municipal policy or custom, and it did not specify the contents of the policies or practices that allegedly caused the injuries.

The court also held that Claim 7, alleging negligent hiring, training, and supervision by San Francisco, lacked an identified statutory basis for direct public-entity liability. In addition, Alapati’s written claim to San Francisco did not identify negligent hiring, training, or supervision; it instead described inadequate medical care in her individual case. The remainder of the claim was dismissed without prejudice under the order’s concluding disposition, and Alapati was allowed to amend.

Intentional emotional distress, assault and battery, and the Bane Act. The court dismissed the intentional-infliction-of-emotional-distress claim based on medical treatment because the complaint did not allege that the treatment was given in bad faith or calculated to cause severe emotional distress. It found, however, that the allegation that Nurse Beshue forcibly yanked Alapati from the ground and accused her of faking her symptoms adequately stated Claim 8 against Beshue. San Francisco was dismissed with prejudice from Claim 8 because Alapati had not presented that claim in her written claim to the county.

The court found that the same alleged conduct adequately stated assault and battery against Nurse Beshue in Claim 10. To the extent Claim 10 was asserted against San Francisco, the court found it barred for lack of proper claim presentation; the order’s conclusion states that the remaining claims and parties were dismissed without prejudice unless otherwise specified.

The court dismissed Claim 11, based on California Government Code section 845.6, with prejudice as to all defendants. That statute addresses failure to summon medical care, and the complaint alleged that jail staff provided some evaluation and treatment, even if the treatment was inadequate.

The court found that Claim 12, under California’s Bane Act, was adequately alleged against Nurse Beshue because the alleged conduct could support reckless disregard of Alapati’s right to receive medical care. The remaining medical defendants were dismissed without prejudice, the unidentified defendants were dismissed without prejudice, and San Francisco was dismissed with prejudice.

Disability claims. The court dismissed the Americans with Disabilities Act claim against San Francisco without prejudice. The complaint did not identify a specific service, program, or activity from which Alapati was excluded because of her disability. The court also explained that inadequate medical treatment, without discriminatory exclusion from medical services, does not by itself state an Americans with Disabilities Act claim.

The court dismissed San Francisco with prejudice from the Unruh Civil Rights Act claim, but dismissed the claim as a whole with leave to amend to add qualifying private businesses if appropriate. The court dismissed the California Disabled Persons Act claim with leave to amend because that law concerns physical access to public spaces, while the complaint alleged inadequate services and sanitation rather than a physical-access barrier.

Disposition

Judge Illston granted in part and denied in part the defendants’ motion to dismiss. The claims that remained adequately pleaded were the Fourteenth Amendment medical-care claim subject to amendment identifying the applicable standard, negligence against the medical defendants other than Nurse Williams, negligent infliction of emotional distress against the medical defendants, intentional infliction of emotional distress against Nurse Beshue, assault and battery against Nurse Beshue, and the Bane Act claim against Nurse Beshue. The court dismissed specified claims with prejudice and dismissed the remainder without prejudice, granting leave to amend by April 29, 2022.