Shepherd v. Dallas County

        IN THE UNITED STATES COURT OF APPEALS
                FOR THE FIFTH CIRCUIT  United States Court of Appeals
                                                Fifth Circuit

                                             FILED
                                                               December 18, 2009

                                  No. 08-10918               Charles R. Fulbruge III
                                                                     Clerk

STANLEY SHEPHERD

                                     Plaintiff–Appellee Cross-Appellant
v.

DALLAS COUNTY

                                     Defendant–Appellant Cross-Appellee




                 Appeal from the United States District Court
                      for the Northern District of Texas
                           USDC No. 3:05-CV-1442


Before JONES, Chief Judge, and GARZA and STEWART, Circuit Judges.
EDITH H. JONES, Chief Judge:
      Stanley Shepherd, a pretrial detainee, suffered a stroke and permanent

disability due to the failure of the Dallas County Jail to administer the pills he

had to take to ameliorate his chronic hypertension. That failure, Shepherd

showed below, was not an unintended error but the predictable result of a de

facto policy that denied inmates adequate care for chronic conditions.          At

summary judgment, the district court ruled that Shepherd’s § 1983 claim was

best characterized as a challenge to his conditions of confinement, and the jury
                                  No. 08-10918

subsequently awarded him $890,336 in damages.             Dallas County appeals,

contending, inter alia, that the district court erred in so characterizing

Shepherd’s claim and in instructing the jury. Because this is the rare case in

which a plaintiff demonstrated deficiencies in the conditions of confinement that

amounted to punishment before he was judged guilty and thus violated due

process of law, Bell v. Wolfish, 441 U.S. 520, 535, 99 S. Ct. 1861, 1872 (1979), the

district court’s judgment is AFFIRMED.

                               I. BACKGROUND

      On October 4, 2003, Stanley Shepherd was booked into the Dallas County

Jail as a pretrial detainee. At intake, he informed a nurse at the jail that he had

hypertension and had been taking Clonidine twice daily to treat that condition.

      In his first two weeks at the jail, Shepherd requested Clonidine several

times—one nurse practitioner recorded that he “wants and insists on

Clonidine”—and, after a high blood-pressure reading on October 14, 2003, he

was prescribed a different medication. Despite frequent complaints, he waited

weeks between doses, was not monitored, and received no other medical

treatment.

      On November 27, Shepherd was brought to the jail clinic complaining of

a severe headache. His blood pressure was high—165/117. Dr. Kathryn Flangin


                                         2
                                 No. 08-10918

ordered that Shepherd be given one dose of Clonidine and that his blood

pressure be checked for three days.

      Four days later, on December 1, Shepherd’s blood pressure read 181/133,

a level considered a “hypertensive emergency.” He was given nitroglycerine and

a prescription for twice-daily doses of Clonidine.

      On December 3, Shepherd experienced a second hypertensive emergency,

with his blood pressure reading 242/132.      At that time, a nurse noted on

Shepherd’s chart that he “had not received his Clonidine as ordered.” He was

administered an initial dose, which proved effective.

      For the next seven weeks, Shepherd received no medical treatment. His

medication was not dispensed as prescribed, and no medical provider checked

his blood pressure. The record shows that he and his wife, who was aware of the

situation, complained to jail staff and medical personnel about the lack of

treatment.   His wife, in particular, repeatedly expressed the concern that

Shepherd would have a stroke if he did not receive his medication regularly.

      Shepherd did not see a medical provider until January 22, 2004. Early

that afternoon, he went to the nurse’s station complaining of weakness on the

left side of his body and hypertension. A nurse took his blood pressure, which

was high, and reported it to Dr. Flangin, who ordered the nurses to monitor



                                        3
                                  No. 08-10918

Shepherd’s blood pressure and administer doses of two drugs, Lasix and

Lopressor. Shepherd was sent back to his cell, over his protests that he was not

well.

        An hour later, Shepherd was found lying on the floor of his cell, with

slurred speech, sweating, and left-side weakness. He was immediately taken by

ambulance to the hospital, where doctors concluded that he had suffered a stroke

because of a hypertensive emergency. After 26 days in the hospital, he was

discharged to a rehabilitation center, where he recuperated for several months.

        Since his stroke, Shepherd has been permanently confined to a wheelchair,

has lost most of his left-side functions, suffered impairment of his left-side sight

and hearing, and has slurred speech.

        In 2005, Shepherd filed suit against Dallas County seeking damages under

42 U.S.C. § 1983 for violations of his Fourteenth Amendment right to medical

care while in custody, challenging both specific “episodic acts and omissions” and

the “conditions of confinement.” The district court granted summary judgment

to the County on Shepherd’s episodic acts claim, on the ground that he failed to

identify any jail employee who had shown deliberate indifference to his plight,

but it allowed his “conditions of confinement” claim to proceed to trial.




                                         4
                                  No. 08-10918

      At trial, Shepherd presented extensive evidence on the jail’s treatment of

inmates with chronic illness. Witnesses, including the jail’s Medical Director at

the time of Shepherd’s confinement, the jail’s pharmacist, and an employee of

the medical services contractor responsible for monitoring the jail’s contract,

testified that the jail’s medical program was understaffed to the point that

routine treatment could not be provided; that at times, no medical personnel

were present at the jail; that fifty percent or more of prescriptions regularly went

undelivered to inmates; that records concerning medication administration were

regularly falsified; and that Dallas County officials had been repeatedly notified

of these problems.

      Two extensive reports entered into evidence buttressed Shepherd’s claims.

In December 2004, Dallas County retained Health Management Associates

(“HMA”) to perform a comprehensive review of the health services at the Dallas

County Jail. The review was performed, and a report written, by a team led by

Dr. Michael Puisis (“Dr. Puisis”), an expert in correctional health. Dr. Puisis

made the following findings in his report to the County:

      •     The jail has “no capacity to diagnose illness at intake”

            (emphasis in the original). Further, “There is no policy or

            procedure for how inmates who come into the jail at intake



                                         5
                          No. 08-10918

    are to receive their medication or be referred to a physician.”

    Overall, “only about 25% of incoming inmates with a chronic

    illness are actually physically seen by a physician following

    intake,” with the result that “[p]atients with chronic illness

    . . . may never be adequately evaluated.”

•   “The sick call process in Dallas County Jail is not adequate

    and its steady state is that inmates, by attrition, leave the jail

    before being seen more frequently than being appropriately

    evaluated.” Dr. Puisis found “multiple barriers to access” to

    care, including a dysfunctional “kite” system for inmate

    requests; the lack of timely review of health care requests by

    nurses; the unavailability of officers to bring inmates for

    health services; the lack of adequate capacity to examine

    inmates who manage to appear at sick call; and understaffing

    of physicians.

•   Monitoring of inmates with chronic conditions is “poor to non-

    existent.” Specifically: “There are no policies, procedures or

    chronic care guidelines that are used in the management of

    chronic diseases. There is no mechanism to track individuals



                                 6
                                 No. 08-10918

            who have a chronic illness . . . , and there is no mechanism in

            place to assign acuity to patients with chronic illness.”

            Generally, inmates with chronic illness are seen only “when

            their conditions deteriorate to an urgent status”; inmates

            whose conditions have not yet reached that point “usually are

            discharged before being seen” by a doctor. The result of this

            system, according to Dr. Puisis’s review of inmate medical

            charts, is “disease deterioration to the point of requiring

            hospitalization.”

      Dr. Puisis’s findings were echoed in a 2006 report by the Department of

Justice (“DOJ”). In on-site inspections in February and March 2006, the DOJ

found that the jail “fails to adequately identify inmates’ health needs through

appropriate intake screening, thereby preventing inmates from receiving

adequate care for acute or chronic needs.” The jail “has no clinical practice

guidelines for chronic and communicable diseases,” including hypertension. It

“fails to ensure that inmates receive thorough assessments and monitoring of

their chronic illnesses.” Care for inmates with chronic conditions is “plagued by

delays in the treatment and administration of medication.” Like Dr. Puisis, the

DOJ found that the system for obtaining medical treatment was “inadequate”



                                       7
                                  No. 08-10918

due, in large part, to “significant” barriers to access, including a complete lack

of any protocols for collecting, processing, distributing, logging, and triaging

medical requests. The jail regularly lost track of inmates with chronic illness

and, overall, “fails to provide adequate treatment for their needs.” The DOJ was

particularly critical of the jail’s system of administering medication, as a result

of which “inmates routinely miss doses of life-sustaining medications.” The DOJ

identified numerous cases where inmates suffered or died because of the jail’s

inadequate treatment of chronic conditions.       It concluded that the jail was

operating in violation of inmates’ constitutional right to adequate medical care.

      The jury rendered a verdict for Shepherd, and a judgment was entered in

his favor. Both parties appealed.

                               II. DISCUSSION

      Dallas County raises four issues in this appeal: (1) whether the district

court erred in classifying the plaintiff’s § 1983 claim as an attack on conditions

of confinement; (2) whether the district court erred in failing to require the jury

to find that the County adopted or maintained any unconstitutional conditions

of confinement with the intent to punish pretrial detainees; (3) whether the

jury’s verdict was supported by sufficient evidence; and (4) whether the district

court erred in allowing the entirety of the DOJ report, including its conclusions,



                                        8
                                   No. 08-10918

to be admitted into evidence. In a protective cross-appeal, Shepherd challenges

the district court’s grant of summary judgment to the County on his episodic acts

or omissions claim.

                        A. Conditions of Confinement

      Dallas County first contends that the district court erred in classifying the

plaintiff’s § 1983 lawsuit as an attack on conditions of confinement rather than

the episodic acts or omissions of particular jail officials.

      Constitutional challenges by pretrial detainees may be brought under two

alternative theories: as an attack on a “condition of confinement” or as an

“episodic act or omission.” Hare v. City of Corinth, Miss., 74 F.3d 633, 644–45

(5th Cir. 1996) (en banc). If the plaintiff has properly stated a claim as an attack

on conditions of confinement, he is relieved from the burden of demonstrating

a municipal entity’s or individual jail official’s actual intent to punish because,

as discussed below, intent may be inferred from the decision to expose a detainee

to an unconstitutional condition. A condition is usually the manifestation of an

explicit policy or restriction: the number of bunks per cell, mail privileges,

disciplinary segregation, etc. See Scott v. Moore, 114 F.3d 51, 53 n.2 (5th Cir.

1997) (en banc) (listing cases deemed to state challenges to conditions of

confinement). In some cases, a condition may reflect an unstated or de facto


                                         9
                                  No. 08-10918

policy, as evidenced by a pattern of acts or omissions “sufficiently extended or

pervasive, or otherwise typical of extended or pervasive misconduct by [jail]

officials, to prove an intended condition or practice.” Hare, 74 F.3d at 645.

Proving a pattern is a heavy burden, one that has rarely been met in our

caselaw. Further, to constitute impermissible punishment, the condition must

be one that is “arbitrary or purposeless” or, put differently, “not reasonably

related to a legitimate goal.” Bell v. Wolfish, 441 U.S. 520, 539, 99 S. Ct. 1861,

1874 (1979).

      More often, however, a plaintiff’s claim, properly characterized, faults

specific jail officials for their acts or omissions because the plaintiff cannot

establish the existence of an officially sanctioned unlawful condition. In these

cases, “an actor usually is interposed between the detainee and the municipality,

such that the detainee complains first of a particular act of, or omission by, the

actor and then points derivatively to a policy, custom, or rule (or lack thereof)

of the municipality that permitted or caused the act or omission.”          Scott,

114 F.3d at 53. Because the focus of the claim is one individual’s misconduct,

the detainee is required to prove intent—specifically, that one or more jail

officials “acted or failed to act with deliberate indifference to the detainee’s

needs.” Hare, 74 F.3d at 648.


                                       10
                                       No. 08-10918

       Dallas County contends that the district court erred in classifying

Shepherd’s lawsuit by denying it summary judgment on his conditions-of-

confinement claim.1 Shepherd’s case, the County argues, is no more than an

episodic-acts-or-omissions claim: if his rights were violated, specific acts of

specific County employees were to blame, not County policy.

       In support of this argument, the County points to several cases found to

state episodic acts rather than conditions-of-confinement claims. In Scott, this

court held that a § 1983 lawsuit over a sexual assault, which the plaintiff argued

was the result of constitutionally inadequate staffing, could not be classified as

a conditions claim because the plaintiff did not suffer from that alleged unlawful

condition but from an individual’s specific act, the assault, committed on a single

occasion. Scott, 114 F.3d at 53–54. Similarly, in Sibley, this court held that the

lawsuit of a mentally disturbed detainee who had been allowed to pluck out his

eyeballs while left alone and shackled was properly classified as an episodic act

or omission because, again, the plaintiff’s injuries were caused by specific alleged



       1
          Dallas County further argues that the district court did not properly classify
Shepherd’s lawsuit because it considered both claims on the merits, granting the County
summary judgment on the episodic-acts-or-omissions claim and allowing the conditions-of-
confinement claim to proceed to trial. This procedure, however, was an entirely appropriate
manner of choosing between two alternative claims when the evidence clearly supported one
and not the other. Further, the district judge is no more required to classify a § 1983 lawsuit
than any other case in which multiple theories are pled in the alternative. In the present case,
as discussed infra, a fact issue existed only on the conditions of confinement claim.

                                              11
                                      No. 08-10918

acts or omissions. Sibley v. Lemaire, 184 F.3d 481, 487–88 (5th Cir. 1999). And

in Hare, this court held that a § 1983 lawsuit concerning the suicide of a

detainee was not properly classified as an attack on the general conditions and

practices of detainment because the claim was premised on jail officials’ episodic

acts or omissions. Hare, 74 F.3d at 643–45, 650.

       Shepherd’s claim, by contrast, does not implicate the acts or omissions of

individuals but the jail’s system of providing medical care to inmates with

chronic illness. His original complaint contains the full theory of the case: The

jail’s evaluation, monitoring, and treatment of inmates with chronic illness was,

at the time of Shepherd’s stroke, grossly inadequate due to poor or non-existent

procedures and understaffing of guards and medical personnel, and these

deficiencies caused his injury. Shepherd relied on evidence showing that the

inadequate treatment he received in a series of interactions with the jail’s

medical system inevitably led to his suffering a stroke.2 To demonstrate the

existence of an unlawful condition, he presented extensive independent evidence

on the jail’s treatment of inmates with chronic illness. This evidence included

a comprehensive evaluative report commissioned by the County, the DOJ report,



       2
         Because no single individual’s error actually caused his hypertensive decline into a
stroke, Shepherd’s protective cross-appeal, challenging the district court’s grant of summary
judgment to the County on his episodic-acts-or-omissions claim, must fail.

                                             12
                                  No. 08-10918

affidavits from employees of the jail and its medical contractor attesting to the

accuracy and applicability of the reports, and a plethora of additional documen-

tary evidence. From this evidence, the court could reasonably infer a de facto jail

policy of failing properly to treat inmates with chronic illness.

      Further, the condition that Shepherd alleged to be unlawful is cognizable

as punishment under Bell and its progeny. “Not every disability imposed during

pretrial detention amounts to ‘punishment’ in the constitutional sense.” Bell,

441 U.S. at 537, 99 S. Ct. at 1873. “[T]he effective management of the detention

facility . . . is a valid objective that may justify imposition of conditions and

restrictions of pretrial detention.” Id. at 540, 99 S. Ct. at 1875. Detainment

itself, however, requires that the State provide for inmates’ basic human needs:

      When the State by the affirmative exercise of its power so restrains
      an individual’s liberty that it renders him unable to care for himself,
      and at the same time fails to provide for his basic human
      needs—e.g., food, clothing, shelter, medical care, and reasonable
      safety—it transgresses the substantive limits on state action set by
      the Eighth Amendment and the Due Process Clause.                  The
      affirmative duty to protect arises not from the State’s knowledge of
      the individual’s predicament or from its expressions of intent to help
      him, but from the limitation which it has imposed on his freedom to
      act on his own behalf.

Hare, 74 F.3d at 639 (quoting DeShaney v. Winnebago County Department of

Soc. Serv., 489 U.S. 189, 200, 109 S. Ct. 998, 1005–1006 (1989)). Thus, isolated

examples of illness, injury, or even death, standing alone, cannot prove that

                                        13
                                   No. 08-10918

conditions of confinement are constitutionally inadequate. Nor can the incidence

of diseases or infections, standing alone, imply unconstitutional confinement

conditions, since any densely populated residence may be subject to outbreaks.

Allegations of insufficient funding are similarly unavailing. Rather, a detainee

challenging jail conditions must demonstrate a pervasive pattern of serious

deficiencies in providing for his basic human needs; any lesser showing cannot

prove punishment in violation of the detainee’s Due Process rights.            Here,

Shepherd demonstrated that serious injury and death were the inevitable

results of the jail’s gross inattention to the needs of inmates with chronic illness.

In the absence of any legitimate penological or administrative goal, this amounts

to punishment.

      We therefore reject the County’s claim that the district court improperly

classified Shepherd’s lawsuit at summary judgment.

                              B. Intent To Punish

      Dallas County next contends that the district court erred in failing to

require the jury to find that any unlawful conditions of confinement were

adopted or maintained by the County with an intent to punish.

      The law, however, is clear that an official intent to punish may be

presumed when the plaintiff, as in this case, attacks general conditions,



                                         14
                                   No. 08-10918

practices, rules, or restrictions of pretrial confinement.         Bell at 538–39,

99 S. Ct. at 1873–1874. A showing of express intent to punish is not required.

Instead, such intent may be presumed where a policy is otherwise senseless:

      [I]f a particular condition or restriction of pretrial detention is
      reasonably related to a legitimate governmental objective, it does
      not, without more, amount to “punishment.” Conversely, if a
      restriction or condition [of pretrial confinement] is not reasonably
      related to a legitimate goal—if it is arbitrary or purposeless—a
      court permissibly may infer that the purpose of the government
      action is punishment that may not constitutionally be inflicted upon
      detainees qua detainees.

Bell at 539, 99 S. Ct. at 1874 (footnote omitted).

      Nonetheless, Dallas County urges that a plaintiff challenging conditions

of confinement must prove intent—specifically, deliberate indifference. But as

this court, sitting en banc, explained in Hare, the jail officials’ individual states

of mind are not a disputed issue in such cases:

      In true jail condition cases, an avowed or presumed intent by the
      State or its jail officials exists in the form of the challenged
      condition, practice, rule, or restriction. A State’s imposition of a rule
      or restriction during pretrial confinement manifests an avowed
      intent to subject a pretrial detainee to that rule or restriction.
      Likewise, even where a State may not want to subject a detainee to
      inhumane conditions of confinement or abusive jail practices, its
      intent to do so is nevertheless presumed when it incarcerates the
      detainee in the face of such known conditions and practices. Thus,
      a true jail condition case starts with the assumption that the State
      intended to cause the pretrial detainee’s alleged constitutional
      deprivation.


                                         15
                                   No. 08-10918

Hare, supra, 74 F.3d 644–45. This standard is “functionally equivalent to a

deliberate indifference inquiry,” id. at 643, because, in a true jail conditions case,

the plaintiff has shown either an official policy, intentionally adopted, or a series

of “acts or omissions . . . sufficiently extended or pervasive, or otherwise typical

of extended or pervasive misconduct by other officials, to prove an intended

condition.” Id. at 645. Only when the plaintiff has made such a showing may

the jury reasonably presume that the government acted with the requisite intent

to punish.

      The district court properly instructed the jury on this point. Shepherd, the

jury was charged, had the burden of “demonstrat[ing] the existence of an

identifiable intended condition or practice” that was “not reasonably related to

a legitimate governmental objective.” Such a practice, the court instructed

(tracking the language of Hare), may be either “an established rule or

restriction” or acts or omissions “sufficiently extended or pervasive . . . to prove

an intended condition or practice.” Evidence showing only “isolated instances

of inadequate medical care,” the court clearly instructed, would be insufficient.

These instructions do not, as Dallas County argues, permit a finding of

municipal liability premised upon negligence or strict liability. Consistent with

the law, they allowed the jury to infer intent to punish only when a municipality


                                         16
                                        No. 08-10918

knowingly subjects a detainee to inhumane conditions of confinement or abusive

jail practices.3




       3
         It is unnecessary to quote the court’s entire instruction, but the most salient parts
that refute the County’s criticism are as follows:

                To establish that his Fourteenth Amendment rights were violated
       because of the general conditions of his confinement, Shepherd must prove by
       a preponderance of the evidence that the general level of medical care provided
       to pretrial detainees during the time he was detained at the Dallas County Jail
       was not reasonably related to a legitimate governmental objective and therefore
       punished him, in violation of his Fourteenth Amendment due process rights.
       In other words, he must prove that the level of medical care provided generally
       at the Jail was so inadequate that it resulted in a serious deprivation of his
       basic human needs, and that the level of care provided was not reasonably
       related to a legitimate governmental objective.
                Pretrial detainees are not entitled under the Constitution to the best
       medical care available or to the level of medical care that may be available to
       persons who are not detained or incarcerated, provided the level of medical care
       they receive does not seriously deprive them of their basic human needs, or the
       level of medical care is reasonably related to a legitimate governmental
       objective.
                To prove that Shepherd received an inadequate level of medical care as
       a result of general conditions of confinement, it is not sufficient to show that he
       received isolated instances of inadequate medical care, including medical
       malpractice or unsuccessful medical treatment, or suffered from episodic acts
       or omissions of jail officials, unless they are indicative of a systemwide problem.
       In other words, if Shepherd relies on an act or omission of a particular jail
       official to prove his claim, the act or omission must implement either a rule or
       restriction, or it must otherwise demonstrate the existence of an identifiable
       intended condition or practice. If Shepherd is unable to point to such an
       established rule or restriction, then he must show that the jail official’s acts or
       omissions were sufficiently extended or pervasive, or otherwise typical of
       extended or pervasive misconduct by other officials, to prove an intended
       condition or practice.

                                               17
                                  No. 08-10918

                       C. Sufficiency of the Evidence

      Dallas County maintains that the district court erred in denying its motion

for judgment as a matter of law on Shepherd’s conditions-of-confinement claim

because Shepherd’s evidence was legally insufficient. The County’s arguments

in support of this contention in large measure mirror those already disposed of:

that Shepherd’s evidence concerned only episodic acts and that he failed to

present evidence of intent. Cloaking these contentions in a new guise does not

make them any more persuasive. The County additionally argues that the

evidence presented by Shepherd did not concern the time period of his

confinement, October 4, 2003, through January 22, 2004, and that he therefore

failed to establish the state of conditions during that period.

      We review a district court’s ruling on a motion for judgment as a matter

of law de novo. In an action tried by jury, a motion for judgment as a matter of

law is a challenge to the legal sufficiency of the evidence supporting the jury’s

verdict. The jury verdict must be upheld unless “a reasonable jury would not

have a legally sufficient evidentiary basis to find for the party on that issue.”

McBeth v. Carpenter, 565 F.3d 171, 176 (5th Cir. 2009).

      Dallas County, however, waived its right to appeal the sufficiency of the

evidence because it did not file a motion under Federal Rule of Civil


                                       18
                                  No. 08-10918

Procedure 50(b) for judgment as a matter of law after the jury’s verdict. “[A]

Rule 50(b) motion is necessary to preserve an argument for appellate review

even when a Rule 50(a) motion was denied after all the evidence was presented.”

Downey v. Strain, 510 F.3d 534, 543 (5th Cir. 2007) (citing Unitherm Food Sys.,

Inc. v. Swift-Eckrich, Inc., 546 U.S. 394, 400–01, 126 S Ct. 980, 163 (2006)).

Here, the record shows that Dallas County made a Rule 50(a) motion at the close

of Shepherd’s case and again at the close of its own case. It failed, however, to

move for judgment as a matter of law or a new trial after the jury’s verdict.

      Accordingly, our review is limited to plain error. Polanco v. City of Austin,

Tex., 78 F.3d 968, 974 (5th Cir. 1996). Under this standard, “the question before

this Court is not whether there was substantial evidence to support the jury

verdict, but whether there was any evidence to support the jury verdict.” Id.

      Plainly, Shepherd has carried this minimal burden with extensive

testimony from jail and UTMB employees on conditions present while he was in

jail. For example, Dr. Steven Bowers, medical director of the Dallas County Jail

at the time of Shepherd’s detention, testified that jail conditions were consistent

with those reported by Dr. Puisis in the HMA report and that the jail’s medical

services were inadequate. Paul Roach, the jail’s clinical pharmacist at the time

of Shepherd’s detention, testified that the administration of medication at the


                                        19
                                  No. 08-10918

jail was so inadequate that, according to surveys he conducted, half or more of

inmates did not receive their prescription medications. And Shepherd himself

testified as to the conditions that he directly experienced.

      The evidence is more than sufficient to insulate the jury’s verdict from

plain error.

                   D. The Department of Justice Report

      Finally, Dallas County argues that the district court erred under Federal

Rule of Evidence 403 in admitting the DOJ Report into evidence.

      In reviewing a district court’s Rule 403 determinations, “we give great

deference to the court’s informed judgment and will reverse only after a clear

showing of prejudicial abuse of discretion.” United States v. Peden, 961 F.2d 517,

521 (5th Cir. 1992). This deference is appropriate because “Rule 403 . . . is an

extraordinary measure [that] permits a trial court to exclude concededly

probative evidence, and thus it should be used sparingly.” United States v.

Clark, — F.3d —, 2009 WL 2195985, at *11 (5th Cir. 2009). Thus, “[w]hen

reviewing this exercise of discretion, we must look at the evidence in the light

most favorable to the proponent, maximizing its probative value and minimizing

its prejudicial effect.” Id.




                                       20
                                  No. 08-10918

      Rule 403 allows the exclusion of otherwise admissible evidence “if its

probative value is substantially outweighed by the danger of unfair prejudice,

confusion of the issues, or misleading the jury.”     When the subject of this

balancing test is a government report or other public record, the court must take

care to ensure that Rule 403 does not undermine the policy in favor of the

admission of such evidence that is embodied in Rule 803(8)(C). See Moss v. Ole

South Real Estate, Inc., 933 F.2d 1300, 1308–09 (5th Cir. 1991) (magistrate

judge abused discretion under Rule 403 by excluding two trustworthy

government evaluative reports on the grounds that the jury would find them

confusing and accord their conclusions undue weight).

      In the present case, Dallas County objected on Rule 403 grounds to the

admission of the entire DOJ report regarding the County’s provision of medical

care at the jail and the constitutionality of jail conditions. The County makes

three arguments supporting this claim. First, the report’s authors may have

lacked the requisite skill or expertise to opine on jail conditions. Second, the

report had little relevance because it does not purport to address jail conditions

at the time of Shepherd’s detention.        And third, the report was unduly

prejudicial because the jury afforded its conclusions undue weight, effectively

“ced[ing]” its factfinding duty to the Department of Justice.


                                       21
                                  No. 08-10918

      Addressing these arguments in order, we first reject the County’s attack

on the credibility of the report’s authors. Questions of credibility are properly

for the jury. United States v. Thompson, 615 F.2d 329, 332–33 (5th Cir. 1980)

(“Rule 403 does not permit exclusion of evidence because the judge does not find

it credible.”). The jury was carefully instructed on its duty to evaluate the

credibility of the witnesses and evidence before it.

      Second, the report’s relevance cannot be seriously doubted. Shepherd

alleged that medical care at the jail was constitutionally inadequate, and the

report’s recitation of facts and findings provide strong support for that claim.

The findings that the County now contests (the record shows that County

officials did not challenge them in meetings with the DOJ in Washington) are

well-grounded in facts obtained through personal observation of the jail during

several visits, interviews of jail personnel, and reviews of jail policies and

procedures, incident reports, grievances, and medical records. Though the report

was released in 2006, it describes incidents going back to 2002. In particular,

it reports numerous specific incidents of failure to provide adequate medical care

that occurred shortly before, during, and shortly after the period of Shepherd’s

detention from late 2003 to early 2004. Further, several witnesses testified that




                                       22
                                  No. 08-10918

the report accurately reflected jail conditions at that time or that conditions had

changed little between late 2003 and early 2006.

      Third, the report’s findings were not unfairly prejudicial in terms of the

weight that a jury would accord them.         Rule 803(8)(C) contemplates the

admission of reports, such as this, containing “factual findings resulting from an

investigation made pursuant to authority granted by law.” The findings in the

DOJ report were undoubtedly prejudicial to the County’s cause, but they were

probative as well. The County merely labels them “unprincipled, conclusory and

simplistic,” a characterization reasonably rejected by the trial court and, outside

of this litigation, by the County itself. The court did not abuse its discretion in

refusing to exclude this relevant evidence.

                              IV. CONCLUSION

      For the reasons discussed above, the judgment of the district court is

AFFIRMED.




                                        23