Jurasek v. Utah State Hospital

                                                                     F I L E D
                                                               United States Court of Appeals
                                                                       Tenth Circuit
                                  PUBLISH
                                                                      OCT 14 1998
                 UNITED STATES COURT OF APPEALS
                                                                 PATRICK FISHER
                                                                           Clerk
                              TENTH CIRCUIT



JAN E. JURASEK,

      Plaintiff-Appellant,

           v.                                      No. 97-4082

UTAH STATE HOSPITAL; K.V.
GREENWOOD, Adult II Psychiatrist;
JOHN NILSEN, individually and as
psychiatrist, Utah State Hospital;
MARK PAYNE, individually and as
Administrative Superintendent, Utah
State Hospital; CRAIG HUMMEL,
individually and as Clinical Director,
Utah State Hospital; BRUCE A.
GUERNSEY, individually and as
psychiatrist, Utah State Hospital; and
DR. JAMES HARDY, individually and
as psychiatrist, Utah State Hospital,

      Defendants-Appellees.


AMERICAN ORTHOPSYCHIATRIC
ASSOCIATION (“AOA”),

      Amicus Curiae.


                Appeal from the United States District Court
                          for the District of Utah
                           (D.C. No. 91-CV-979)
Linda V. Priebe, Brazelon Center for Mental Health Law, of Washington, D.C.
(Erin Bradley Yeh, Disability Law Center, of Salt Lake City, Utah, with her on
the brief), for the appellant.

Debra J. Moore, Assistant Utah Attorney General, of Salt Lake City, Utah, for the
appellees.

John Townsend Rich and Jodi L. Short, Shea & Gardner, of Washington, D.C., on
the brief for amicus curiae.


Before BRISCOE, McWILLIAMS, and MURPHY, Circuit Judges.


BRISCOE, Circuit Judge.


      Jan Jurasek appeals the district court’s entry of summary judgment in favor

of defendants in this action brought under 42 U.S.C. § 1983. Jurasek, who was

civilly committed and hospitalized for mental illness, claimed defendants violated

his rights under the Due Process Clause of the Fourteenth Amendment and his

rights of free expression under the First Amendment by forcibly medicating him

with psychotropic drugs. We exercise jurisdiction pursuant to 28 U.S.C. § 1291

and affirm.

                                        I.

      Jurasek is a paranoid schizophrenic who was civilly committed to the Utah

State Hospital on April 12, 1991. At the commitment hearing, a Utah state court

determined (1) Jurasek suffered from a mental illness, (2) Jurasek posed an

immediate physical danger to himself and others because of his mental illness, (3)

                                        -2-
Jurasek lacked the ability to engage in rational decision-making regarding the

acceptance of mental treatment, (4) there was no appropriate less-restrictive

alternative to a court order of commitment, and (5) the Hospital could provide

Jurasek with adequate and appropriate treatment. Jurasek was examined by an

independent psychiatrist prior to the commitment hearing and was represented by

counsel at the hearing. The original commitment was slated to last six months.

At the conclusion of the six months, a   Utah state court reviewed Jurasek’s

commitment and, after finding the five requirements for civil commitment

continued to exist, entered an order extending his commitment for an

indeterminate period. Jurasek remains confined at the Hospital pursuant to this

commitment order.

      Jurasek has been treated with psychotropic drugs    from the time he was first

admitted to the Hospital. He has continuously objected to the treatment and it has

been administered against his will. Since September 1991, the Hospital has had a

series of policies which apply to patients who are involuntarily medicated. Under

the current policy, patients can be forcibly injected with psychotropic drugs if the

Hospital’s involuntary medication hearing committee determines “the patient is,

or will be, gravely disabled and in need of medication treatment or continuing

medication treatment,” or “without the medication treatment or continuing

medication treatment, the [patient] poses or will pose, a likelihood of serious


                                          -3-
harm to himself/herself, others, or their property.” Appellees’ Br., Addendum C

at § 6.9. This policy applies to all patients, including patients with legal

guardians.

       The involuntary medication hearing committee consists of a psychiatrist, a

psychologist, and the hospital program administrator. None of the committee

members are to be involved in the patient’s treatment at the time the decision is

made to forcibly medicate the patient; however, committee members “are not

disqualified from sitting on the committee if they have treated or diagnosed the

patient in the past.”   Id. at § 5.2. It is undisputed that none of the committee

members involved in the multiple decisions to forcibly medicate Jurasek were part

of his treatment team at the time of the decisions.

       In September 1991, Jurasek filed the instant lawsuit in federal district court

seeking injunctive relief and damages on the theory that his subjection to forced

medication violated his Fourteenth Amendment due process and First Amendment

free expression rights under the Constitution. Defendants responded they had not

violated Jurasek’s constitutional rights and, even if they had, the doctrine of

qualified immunity absolved them of liability. In April 1997, the district court

denied Jurasek’s request for injunctive relief and granted defendants’ motion for

summary judgment.




                                            -4-
                                             II.

       This court reviews a grant of summary judgment de novo, applying the

same legal standard used by the district court.       Sundance Assocs., Inc. v. Reno   ,

139 F.3d 804, 807 (10th Cir. 1998). Summary judgment is appropriate “if the

pleadings, depositions, answers to interrogatories, and admissions on file,

together with the affidavits, if any, show that there is no genuine issue as to any

material fact and that the moving party is entitled to a judgment as a matter of

law.” Fed. R. Civ. P. 56(c). “When applying this standard, we examine the

factual record and reasonable inferences therefrom in the light most favorable to

the party opposing summary judgment. If there is no genuine issue of material

fact in dispute, then we next determine if the substantive law was correctly

applied by the district court.”   Wolf v. Prudential Ins. Co. , 50 F.3d 793, 796 (10th

Cir. 1995) (internal citation and quotations omitted).

                                            III.

       It is well established that an individual has a liberty interest in “avoiding

the unwanted administration of antipsychotic drugs under the Due Process Clause

of the Fourteenth Amendment.”       Washington v. Harper , 494 U.S. 210, 221-22

(1990); see Walters v. Western State Hosp.         , 864 F.2d 695, 698 (10th Cir. 1988).

It is also well established that when an individual is confined in a state institution,

individual liberties must be balanced against the interests of the institution in


                                             -5-
preventing the individual from harming himself or others residing or working in

the institution.   Harper , 494 U.S. at 222-23; Bee v. Greaves , 744 F.2d 1387, 1394

(10th Cir. 1984) ( Bee I ). 1 In Harper , the Supreme Court applied this balancing

test and concluded “the Due Process Clause permits the State to treat a prison

inmate who has a serious mental illness with antipsychotic drugs against his will[]

if the inmate is dangerous to himself or others and the treatment is in the inmate’s

medical interest.” 494 U.S. at 227. The question presented in the instant case is

different from that in   Harper because Jurasek is not a prison inmate, but a civilly-

committed patient who has been adjudicated incompetent. Further, Jurasek is

medicated because he is “gravely disabled,” while Harper was medicated because

he was “dangerous to himself or others.” Although the policy at issue in     Harper

also allowed the prison to medicate prisoners who were “gravely disabled,” the

Supreme Court did not pass on that part of the policy.

       The parties agree Jurasek has a liberty interest in avoiding the unwanted

administration of antipsychotic drugs. Presumably, they would also agree the



       1
        In Bee I , we noted in the context of recognizing a plaintiff’s liberty
interests that the forcible administration of antipsychotic drugs “raises First
Amendment concerns” as well because such drugs “have the capacity to severely
and even permanently affect an individual’s ability to think and communicate.”
744 F.2d at 1394. Even if, as Jurasek claims, the forcible administration of
antipsychotic drugs triggers First Amendment rights, such rights are subject to the
same balancing test as liberty interests. Courts thus must determine whether the
individual’s rights are “outweighed by the demands of an organized society.”    Id.

                                           -6-
state has a legitimate interest in the health and safety of its patients and

employees. However, the parties disagree      over how to balance Jurasek’s due

process rights with the Hospital’s interests in health and safety. We conclude the

standards established in   Harper for involuntarily medicating prisoners strike the

appropriate balance. Accordingly, the Due Process Clause allows a state hospital

to forcibly medicate a mentally ill patient who has been found incompetent to

make medical decisions if the patient is dangerous to himself or others and the

treatment is in the patient’s medical interests.

       Our conclusion is based on the fact that treatment with psychotropic drugs

is not punishment. If such treatment was considered      punitive, involuntarily-

committed mental patients would undoubtedly be entitled to greater due process

rights before being forcibly treated.   See Youngberg v. Romeo , 457 U.S. 307,

321-22 (1982) (“Persons who have been involuntarily committed are entitled to

more considerate treatment and conditions of confinement than criminals whose

conditions of confinement are designed to punish.”).     The lack of punishment in

the context of forced medication, however, removes any need to         provide

involuntarily-committed patients with greater due process protection       than

prisoners . Moreover, unlike prisoners, involuntarily-committed patients         have

been adjudicated incompetent      in a prior formal proceeding, thereby minimizing

the potential for any abuse.


                                           -7-
       Our reasoning is further supported by the Supreme Court’s application of

the principles enunciated in   Harper to a pretrial detainee who had been found

incompetent to stand trial, but had not been civilly committed.      See Riggins v.

Nevada , 504 U.S. 127, 135 (1992). Like a mentally incompetent patient

involuntarily committed at a mental health hospital, pretrial detainees have not

been convicted of any crime. One could argue that because         a pretrial detainee has

not been convicted of a crime, he deserves greater due process protections than a

prisoner. The Court, however, implicitly rejected      this argument in Riggins by

applying the Harper standards to an incompetent pretrial detainee.       See also

Morgan v. Rabun , 128 F.3d 694, 697 (8th Cir. 1997),      cert. denied , 118 S. Ct. 1809

(1998) (applying Harper to forcibly medicate an insanity acquittee found

incompetent and ordered committed to mental institution because “governmental

interests in running a state mental hospital are similar in material aspects to that

of running a prison”); Noble v. Schmitt , 87 F.3d 157, 161-62 (6th Cir. 1996)

(applying Harper to involuntarily-committed mental patient’s case without

discussion of differences in status between a prisoner and a civilly-committed

mental patient).

       In deciding to forcibly medicate Jurasek, the Hospital committee

determined Jurasek was “gravely disabled.” The Hospital’s medication policy

defines a “gravely disabled” patient as one who:


                                            -8-
        suffers from a mental disorder such that he or she (a) is in danger of
        serious physical harm resulting from a failure to provide for his [or
        her] essential human needs of health or safety, or (b) manifests, or
        will manifest, severe deterioration in routine function evidenced by
        repeated and escalating loss of cognitive or volitional control over
        his or her actions and is not receiving such care as is essential for his
        or her health or safety.

Appellees’ Br., Addendum C at § 6.9.1. Jurasek argues this assessment did not

justify the committee’s decision   because the Supreme Court has only authorized

forced medication of a mentally ill patient when    a hospital determines the

individual “poses a ‘likelihood of serious harm’ to himself, others, or their

property.” Jurasek also contests the Hospital’s reliance on the commitment

court’s decision that he posed an immediate danger of physical injury to himself

and others, and challenges the committee’s determination that treatment with

psychotropic drugs is in his medical best interests. We consider each argument in

turn.



Grave disability

        In Harper , the Department of Corrections mental health policy permitted

officials to forcibly treat prisoners with psychotropic drugs if the prison medical

committee determined (1) the patient suffered from a mental disorder, (2)

treatment was in the patient’s medical interests, and (3) the patient either posed a

“likelihood of serious harm” to himself, others, or their property, or suffered from


                                           -9-
a “grave disability.” 494 U.S. at 215. Harper was medicated under the

“likelihood of serious harm” prong of the policy. Thus, the Supreme Court did

not specifically determine whether a confined individual found to suffer only

from a “grave disability” may be forcibly medicated within the framework of the

Fourteenth Amendment.

       Nevertheless, the Court’s subsequent discussion of the       Harper requirements

in Riggins sheds some light on this issue. In      Riggins , the Court observed that

“[u]nder Harper , forcing antipsychotic drugs on a convicted prisoner is

impermissible absent a    finding of overriding justification   and a determination of

medical appropriateness.” 504 U.S. at 135 (emphasis added). The Court held due

process requires the state to establish “treatment with antipsychotic medication

was medically appropriate and, considering less intrusive alternatives,      essential

for the sake of Riggins’ own safety or the safety of others     .” Id. (emphasis added).

These statements in Riggins suggest the Court believes a finding of “overriding

justification” is more inclusive than the specifically listed criteria in the forced

medication policy language at issue in     Harper . An individual’s classification as

“gravely disabled,” at least under the definition applied by the Hospital to

Jurasek, provides a sufficiently overriding justification for involuntary

medication.




                                            -10-
       Our next task is to examine the language of the Hospital’s medication

policy to determine whether it appropriately limits the circumstances in which a

patient can be medicated against his will. A patient who is “in danger of serious

physical harm,” Policy § 6.9.1,    is undoubtedly in need of treatment “for the sake

of [his or her] own safety.”   See Riggins , 504 U.S. at 135. Moreover, a patient

who is not receiving care “essential for his or her health or safety,” Policy § 6.9.1,

is, by definition, in need of treatment “for the sake of [his or her] own safety.”

See Riggins , 504 U.S. at 135. We thus conclude the Court’s discussion in

Riggins implicitly authorizes the forced medication of involuntarily-committed

individuals designated as “gravely disabled” under the definition at issue here.

The Hospital’s actions are justified.   2



       Having determined Jurasek can be medicated pursuant to the “grave

disability” prong of the Hospital’s forced medication policy, we need not consider

whether Jurasek’s condition implicates the policy’s “poses an immediate danger

of physical injury to others or himself” component. We note, however, the

commitment court’s determination in 1991 that Jurasek “poses an immediate


       2
          Jurasek’s reliance on Woodland v. Angus , 820 F. Supp. 1497 (D. Utah
1993), is misplaced. In Woodland , the court determined the Hospital’s December
1991 policy was unconstitutional because it did “not require a finding that [the
patient] is dangerous to himself, other, or property.”     Id. at 1518. As explained
above, under the current Hospital policy, a finding that a patient is “gravely
disabled” includes a determination that the patient is “dangerous to himself;”
therefore, the policy is constitutional under     Harper .

                                            -11-
danger of physical injury to others or himself . . . if allowed to remain at liberty”

is of dubious relevance to Jurasek’s   current dangerousness.   See Davis v.

Hubbard , 506 F. Supp. 915, 935 (N.D. Ohio 1980). A commitment court’s

determination is temporal. The court is required to determine whether an

individual “poses an immediate danger of physical injury to others or himself.”

Utah Code Ann. § 62A-12-234(10)(b) (emphasis added). Thus, a hospital may not

rely on a commitment court’s determination unless such an assessment was made

close in time to the hospital’s decision to medicate.



Medical best interests

       Jurasek next argues treatment with Haldol is not in his medical best

interests. In early 1993, Hospital officials determined Jurasek’s condition was not

improving as well as they would have liked with treatment by Haldol and they

began treating him with Prolixin. In April 1996, however, apparently dissatisfied

with the Prolixin results, the Hospital discontinued the Prolixin treatment and

resumed medicating Jurasek with Haldol. Once a patient objects to the forcible

administration of antipsychotic medication, the state bears the burden of

establishing the continued need and medical appropriateness of the treatment.

See Riggins , 504 U.S. at 135.




                                          -12-
      The Hospital’s involuntary medication hearing committee, comprised of

psychologists and psychiatrists not involved in Jurasek’s treatment, has

consistently determined treatment with psychotropic drugs is in Jurasek’s medical

best interests. One of Jurasek’s treating physicians also testified that Jurasek

became increasingly agitated when the Hospital stopped treating him with

psychotropic drugs. Another reported the medications Jurasek “is taking are not

effective in curtailing his psychotic symptomatology; however they are decreasing

somewhat the intensity of his symptoms.” Record II, Doc. 137, Exh. I, at 3. The

fact that a particular method of treatment fails to yield the type of results officials

envisioned does not mean the treatment is inconsistent with the patient’s medical

best interests. In sum, the evidence in the record is uncontroverted that

psychotropic drugs have been, at all times, at least partially beneficial in

Jurasek’s treatment.

      Because Jurasek has been adjudicated gravely disabled and treatment with

psychotropic drugs has been found to be in his medical best interests, the Hospital

may treat him with psychotropic drugs without employing further substantive due

process protections. Of course, the Hospital must afford him procedural due

process before administering such treatment. In    Harper , the Supreme Court found

the hospital had provided the mentally ill prisoner with procedural due process by

employing procedures substantially similar to those used here. 494 U.S. at 228-


                                          -13-
36. Both policies require a committee of independent medical personnel to

examine whether the patient should be treated with psychotropic drugs, permit the

patient to appeal the committee’s decision to a hospital official, authorize the

patient to be present at the hearing with an advisor, and allow the patient to

present evidence and cross-examine witnesses. Further, if the committee finds the

patient should be medicated, the policies require that the committee support its

decision with adequate documentation. In sum, we conclude the Hospital

provided Jurasek with procedural due process.

                                            IV.

      Jurasek insists that, even if   Harper applies, his due process rights were

violated because he has not been determined incompetent to make medical

decisions on his own behalf. Specifically, he argues his 1991 commitment

hearing focused only on whether he should be involuntarily committed and he is

entitled to a separate hearing to adjudicate his competency to make medical

decisions. The Hospital claims the commitment court’s finding that Jurasek

“lacked the ability to engage in a rational decision making process regarding the

acceptance of mental treatment” constitutes a finding that Jurasek is incompetent

to make medical decisions on his own behalf. We agree with the Hospital’s

interpretation.




                                           -14-
      There could hardly be a clearer finding of Jurasek’s inability to make

medical decisions on his own behalf than that found by the commitment court. If

Jurasek believes the commitment court’s determination was wrong or is now

obsolete because of changed circumstances, he can request a review hearing.       See

Utah Code Ann. §§ 62A-12-234(11)(c), 62A-12-242         (local mental health authority

required to reexamine factual predicate for indeterminate commitment orders at

six-month intervals). In fact, the record reveals Jurasek has exercised his right to

reexamination at least once and that another state court judge determined he

continued to satisfy the requirements for commitment listed in § 62A-12-234.       See

Record I, Doc. 136, Exh. E.   3



                                           V.

      Jurasek further suggests    Harper does not apply because he is entitled to the

substituted judgment of a legal guardian. Judy Lord was appointed Jurasek’s

guardian in 1988. She instructed the Hospital to stop medicating Jurasek on

January 27, 1994, and the Hospital initially complied. However, shortly


      3
         Jurasek contends “the periodic civil commitment review hearings in Utah
are[] limited to evaluating whether the patient would constitute a danger if
released.” (Appellant’s Br. at 27). This is an inaccurate statement of Utah law.
See Utah Code Ann. § 62A-12-242 (“Any patient committed pursuant to Section
62A-12-234 is entitled to a reexamination of the order for commitment on the
patient’s own petition, or on that of the legal guardian, . . . to the district court of
the county in which the patient resides or is detained.”);  see also Record I, Doc.
136, Exh. E (Jurasek’s review hearing officer found all five conditions listed in §
62A-12-234 continued to exist).

                                          -15-
thereafter, the Hospital revised its involuntary medication policy to permit the

committee to override Lord’s direction. Citing       Cruzan v. Director, Mo. Dep’t of

Health , 497 U.S. 261 (1990), Jurasek argues a mentally ill person who is

involuntarily committed under the Utah Mental Health Code has a right to have a

legal guardian make medical decisions that are inconsistent with treatment

determined appropriate by the hospital.

       In Cruzan , the Court held that before allowing a guardian to withdraw

hydration and nutrition from an incompetent person in such a way as to cause

death, Missouri could constitutionally require clear and convincing evidence of

the incompetent patient’s wishes.    The Court’s decision assumed a competent

person has a constitutional right to refuse lifesaving hydration and nutrition.

More importantly for our purposes, the Court assumed the guardian had the right

to make such a decision if “clear and convincing evidence” of the patient’s wishes

existed. Id. at 279-80. Jurasek argues       Cruzan stands for the proposition that an

incompetent patient has an absolute right to a guardian’s “substituted judgment.”

       Jurasek’s reading of Cruzan is incorrect for two reasons. First, he ignores

the fact that the Court merely   assumed for purposes of the opinion     that a

guardian, in certain circumstances, has the right to discontinue lifesaving

hydration and nutrition for his or her ward. Second, the gist of the court’s ruling

was even if the guardian had such a right,      that right could be outweighed by the


                                             -16-
state’s interests in preserving life   , absent clear and convincing evidence that the

ward’s wishes are consistent with the guardian’s intentions.

       The Supreme Court in Harper specifically considered the issue of an

incompetent person’s entitlement to the substituted judgment of a guardian       .

Although the opinion is not clear as to whether Harper sought the substituted

judgment of a legal guardian or a judicial officer, the Court unambiguously

declared:

       The alternative means proffered by respondent for accommodating
       his interest in rejecting the forced administration of antipsychotic
       drugs do not demonstrate the invalidity of the State’s policy.
       Respondent’s main contention is that, as a precondition to
       antipsychotic drug treatment, the State must find him incompetent,
       and then obtain court approval of the treatment using a “substituted
       judgment” standard. The suggested rule takes no account of the
       legitimate governmental interest in treating him where medically
       appropriate for the purpose of reducing the danger he poses.    A rule
       that is in no way responsive to the State’s legitimate interests is not a
       proper accommodation, and can be rejected out of hand        .

494 U.S. at 226 (emphasis added).

       Moreover, Jurasek has no absolute right to the “substituted judgment” of a

guardian under Utah law. We acknowledge, of course, that a state may confer

more comprehensive due process protections upon its citizens than does the

federal government.

       Where a State creates liberty interests broader than those protected
       directly by the Federal Constitution, the procedures mandated to
       protect the federal substantive interests . . . might fail to determine
       the actual procedural rights and duties of persons within the State.

                                             -17-
       Because state-created liberty interests are entitled to the protection of
       the federal Due Process Clause, the full scope of a patient’s due
       process rights may depend in part on the substantive liberty interests
       created by state as well as federal law. Moreover, a State may confer
       procedural protections of liberty interests that extend beyond those
       minimally required by the Constitution of the United States. If a
       State does so, the minimal requirements of the Federal Constitution
       would not be controlling, and would not need to be identified in
       order to determine the legal rights and duties of persons within that
       State.

Mills v. Rogers , 457 U.S. 291, 300 (1982) (internal citations omitted). The mere

existence of a state regulatory scheme, however, does not mean the state has

forged a liberty interest. Such regulations take on constitutional significance only

if they employ “explicitly mandatory language in connection with requiring

specific substantive predicates.”    Hewitt v. Helms , 459 U.S. 460, 472 (1983).

       The Utah guardianship statute provides that a guardian of an incapacitated

person has only those “powers, rights, and duties respecting the ward granted in

the order of appointment.” Utah Code Ann. § 75-5-312(1).         4
                                                                      The Utah legislature

has statutorily expressed its preference for limited guardianships.        See id. § 75-5-

304(2) (courts “shall prefer a limited guardianship and may only grant a full

guardianship if no other alternative exists”). If an order of appointment is not

limited, the state vests guardians with specific “powers and duties” subject to



       4
        The order appointing Lord as guardian for Jurasek is not in the record.
Lord testified she believed the guardianship order required her to act as a “go
between” for Jurasek in his dealings with the Hospital.  See Record VI at 6-7.

                                            -18-
modification by order of the court.     Id. § 75-5-312(2). Relevant here is the

provision under which a “guardian      may give any consents or approvals that may

be necessary to enable the ward to receive medical or other professional care,

counsel, treatment or service.”    Id. § 75-5-312(2)(c) (emphasis added).

       Contrary to Jurasek’s argument, this statute does not create a liberty

interest. Its terms are entirely permissive in nature and do not   require hospital

officials to secure a guardian’s consent or approval prior to administering medical

treatment to an incompetent patient under their control. The Eighth Circuit, in

fact, recently found discretionary language in a similar statute to be an

insurmountable impediment to a plaintiff’s state law-based due process claim.

See Morgan , 128 F.3d at 698-99 (Missouri law providing mental facility “     may

authorize the medical and surgical treatment of a patient or resident . . . [u]pon

consent of a parent or legal guardian” does not create federally protected liberty

interest). Nor does the Hospital’s Statement of Patient Rights or Involuntary

Medication of Civilly-Committed Patients Policy contain any language mandating

that the Hospital obtain the consent of Jurasek’s guardian before forcibly




                                            -19-
medicating him with standard psychotropic drugs.          5
                                                              Accordingly, we find the

district court correctly rejected Jurasek’s due process claim.

                                              VI.

       Based on the preceding analysis, we also agree with the district court that

defendants are shielded from liability pursuant to the qualified immunity doctrine.

Qualified immunity protects government officials “performing discretionary

functions . . . from liability for civil damages insofar as their conduct does not

violate clearly established statutory or constitutional rights of which a reasonable

person would have known.”       Harlow v. Fitzgerald , 457 U.S. 800, 818 (1982).

Thus, w hen a defendant asserts a qualified immunity defense, the plaintiff may

proceed to trial only by demonstrating defendant’s actions violated a

constitutional or statutory right, and the constitutional or statutory right was

clearly established at the time of the controverted conduct.          Albright v.

Rodriguez , 51 F.3d 1531, 1534 (10     th
                                            Cir. 1995).

       Our first task in evaluating a defendant’s qualified immunity claim is to

determine whether the plaintiff has alleged any constitutional or statutory




       The Statement of Patient Rights compels hospital officials to procure a
       5

guardian’s consent only before having the patient participate in research projects,
conducting surgical or hazardous assessment procedures, administering the patient
with “unusual medications” or electroconvulsive therapy, using audiovisual
equipment on the patient, and performing procedures for which consent is
required by law. (Pl.’s Mot. for Partial Summ. J., Ex. F, ¶ 17).

                                              -20-
violation. County of Sacramento v. Lewis , 118 S. Ct. 1708, 1714 n.5 (1998).

Only if the plaintiff crosses this threshold do we examine “whether the right

allegedly implicated was clearly established at the time of the events in question.”

Id. Having concluded defendants did not contravene any of Jurasek’s

constitutional or statutory rights, we find defendants are entitled to qualified

immunity.

                                         VII.

      We AFFIRM the district court’s order granting summary judgment in favor

of defendants.




                                         -21-