## Facts

- After a night of drinking, 24-year-old James Smith fell about eight feet from a wall to a Philadelphia sidewalk and was heard groaning and yelling.
- Neighbors observed Smith moving his arms and legs; a 911 call brought Philadelphia Fire Department paramedics Joseph DiFrancesca and Roger Morfitt to the scene.
- A neighbor testified Smith repeatedly stated he hurt his head and neck and said he could not get up.
- The same witness testified the paramedics accused Smith of being drunk, threatened to call police, and—after nudging him—grabbed his arms, hoisted him up, and dragged him to a stretcher without spinal immobilization.
- Viewed in Smith’s favor at summary judgment, Smith’s body went limp when lifted; he was later diagnosed with a cervical spinal cord injury resulting in permanent quadriplegia.
- Smith sued the City and the paramedics under 42 U.S.C. § 1983, alleging the paramedics’ handling of him violated substantive due process under the Fourteenth Amendment.
- The district court denied summary judgment for the paramedics on qualified immunity, finding evidence from which a jury could find subjective deliberate indifference; the paramedics filed an interlocutory appeal. Smith later died, and his estate representative was substituted.

## Issues

1. Whether the court of appeals had jurisdiction in an interlocutory qualified-immunity appeal to review the district court’s determination that genuine disputes of material fact existed.
2. What culpability standard governs a substantive due process claim against paramedics for alleged mishandling of an injured person, and whether the paramedics were entitled to qualified immunity under that standard at summary judgment.

## Decision

- The court dismissed the appeal in part for lack of jurisdiction to the extent the paramedics challenged the district court’s identification of disputed facts.
- The court exercised jurisdiction over the purely legal question of the governing constitutional standard and affirmed the denial of qualified immunity.
- Taking the facts in the light most favorable to Smith, the court held a jury could find the paramedics acted with subjective deliberate indifference and that this standard could satisfy the “shocks the conscience” requirement in the circumstances presented.
- The paramedics were not entitled to qualified immunity as a matter of law at the summary-judgment stage.

## Legal Principles

- In interlocutory qualified-immunity appeals, appellate jurisdiction extends to abstract legal questions but not to challenges to the district court’s determination that the summary-judgment record presents genuine factual disputes.
- Substantive due process liability depends on whether the conduct “shocks the conscience,” with the required culpability varying by context: split-second, high-pressure settings generally require intent to harm, while situations allowing deliberation may be satisfied by subjective deliberate indifference to a known, serious risk.
- When emergency medical responders have sufficient time to recognize and respond to a serious medical risk, deliberate indifference to that risk may constitute conscience-shocking conduct.
- Qualified immunity is unavailable at summary judgment where, under the plaintiff-favorable view of the facts, the evidence could establish a constitutional violation under clearly established law.

## Conclusion

The Third Circuit held that it could not revisit fact disputes on interlocutory appeal, and it affirmed that, on the plaintiff-favorable record, paramedics who had time to assess an apparent neck injury could be found deliberately indifferent in a manner that shocks the conscience, defeating qualified immunity at summary judgment.


Ziccardi v. City of Phila., 288 F.3d 57 (3d Cir. 2002)