## Facts

- Shawanna Nelson, a nonviolent Arkansas state inmate, entered prison custody while pregnant and went into active labor on September 20, 2003.
- Prison medical staff determined she needed immediate transport to a civilian hospital to deliver her child.
- Arkansas Department of Correction policy permitted restraints for medical trips only as needed for safety or to prevent escape and required consideration of the inmate’s medical condition.
- Viewing the record in Nelson’s favor, medical staff indicated restraints were unnecessary given her condition.
- Corrections Officer Patricia Turensky escorted Nelson to the hospital, observed severe contractions and intense pain, and acknowledged Nelson posed no security or escape risk.
- Despite the lack of individualized security concerns, Turensky shackled Nelson’s ankles to opposite sides of the hospital bed and kept them on through most of Nelson’s labor, removing them briefly for examinations and finally removing them only upon a physician’s order for delivery.
- The restraints limited Nelson’s ability to move or assume positions that nursing staff said would assist labor; she received minimal pain relief and could not receive an epidural due to the labor stage.
- Nelson alleged significant physical injuries and chronic pain resulting from being restrained during labor.

## Issues

1. Whether the evidence, viewed in Nelson’s favor, could support a finding that shackling her during active labor constituted deliberate indifference to a substantial risk of serious harm under the Eighth Amendment.
2. Whether, in 2003, the right of an inmate in the final stages of labor to be free from restraints absent a clear and compelling security justification was clearly established, such that Turensky was not entitled to qualified immunity.
3. Whether the evidence supported § 1983 supervisory liability against the corrections director, and whether he was entitled to qualified immunity.

## Decision

- The en banc court affirmed the denial of qualified immunity to Officer Turensky and held that factual disputes precluded summary judgment on the Eighth Amendment claim against her.
- The court held that, by 2003, it was clearly established that restraining a prisoner in the final stages of labor without a clear and compelling, individualized security justification violates the Eighth Amendment; Turensky was therefore not entitled to qualified immunity on Nelson’s version of the facts.
- The court reversed the denial of summary judgment as to the corrections director, concluding the evidence was insufficient for supervisory liability and that he was entitled to qualified immunity.
- The case was remanded for further proceedings consistent with these rulings.

## Legal Principles

- An Eighth Amendment conditions-of-confinement claim may be established by showing deliberate indifference to a substantial risk of serious harm, including when an officer knows of and disregards an excessive risk to an inmate’s health and safety.
- Restraining an inmate during the final stages of labor, without a clear and compelling, individualized security justification, can constitute the unnecessary and wanton infliction of pain prohibited by the Eighth Amendment.
- Qualified immunity is unavailable when the unlawfulness of the conduct is clearly established such that a reasonable officer would understand the conduct violates the Constitution in the circumstances presented.
- Supervisory liability under 42 U.S.C. § 1983 cannot rest on respondeat superior; it requires personal involvement or a causal connection through deliberate indifference in training, supervision, or maintenance of an unconstitutional policy.
- A facially constitutional policy requiring individualized consideration of security and medical needs generally does not support supervisory liability absent evidence the supervisor knew of and disregarded a substantial risk created by how the policy was implemented.

## Conclusion

The court held that, on Nelson’s evidence, shackling a nonviolent inmate during active labor without an individualized, compelling security basis could amount to deliberate indifference and violated clearly established Eighth Amendment law, defeating qualified immunity for the escorting officer, while the corrections director was entitled to qualified immunity due to insufficient proof of supervisory liability.


Nelson v. Corr. Med. Servs., 583 F.3d 522 (8th Cir. 2009) (en banc)