## Facts

- Diane Pierce was a medical resident in a state-run emergency medicine residency program at Texas Tech University Health Science Center (TTUHSC).
- During a trauma rotation at an Arizona hospital, Pierce encountered an aggressive, intoxicated patient who spat in her face while being restrained.
- Pierce slapped the patient in the face multiple times; supervisors removed her from the patient’s care and reported the incident to TTUHSC.
- After Pierce returned to Texas, TTUHSC placed her on probation; the residency director (David Smith), consulting with an assistant dean (Louis Binder), required a psychiatric evaluation and, as part of it, a urinalysis drug test.
- Smith and Binder told Pierce she would be expelled if she refused drug testing and if she did not provide the results to program officials.
- Pierce obtained an independent urinalysis that was negative; Smith accepted the result and lifted her probation.
- Pierce sued under 42 U.S.C. § 1983, alleging the coerced urinalysis and compelled disclosure violated the Fourth and Fourteenth Amendments.
- A jury awarded Pierce compensatory and punitive damages; Smith and Binder appealed, asserting qualified immunity.

## Issues

1. Whether requiring and compelling disclosure of a urinalysis drug test, under threat of expulsion from a state medical residency program, violated the Fourth Amendment for purposes of § 1983.
2. Whether Smith and Binder were entitled to qualified immunity because, in 1990, it was not clearly established that requiring a urinalysis in these circumstances was unconstitutional.

## Decision

- The Fifth Circuit reversed the judgment against Smith and Binder.
- The court held Smith and Binder were entitled to qualified immunity from damages.
- The court assumed urinalysis is a Fourth Amendment “search” but concluded that, in 1990, the unlawfulness of requiring such a test in this setting was not clearly established.
- Because reasonable officials could have believed the testing requirement was lawful given patient-safety and fitness-for-duty concerns, their conduct was objectively reasonable for qualified-immunity purposes.

## Legal Principles

- Qualified immunity protects officials performing discretionary functions unless they violate clearly established constitutional rights that a reasonable person would have known.
- A court assessing qualified immunity asks whether a constitutional violation is alleged and whether the right was clearly established at the time of the challenged conduct.
- Urinalysis drug testing constitutes a search under the Fourth Amendment, but its constitutionality in institutional or employment contexts can depend on the state of clearly established law and the governmental interests at stake.
- Where precedent does not clearly prohibit drug testing in a public-safety/fitness-for-duty setting, officials may be immune from damages even if a violation is assumed.

## Conclusion

The Fifth Circuit held that, because Fourth Amendment limits on requiring urinalysis of a state medical resident in response to serious patient-care misconduct were not clearly established in 1990, the residency officials were protected by qualified immunity and could not be held liable for damages under § 1983.


Pierce v. Smith, 117 F.3d 866 (5th Cir. 1997)