Catherine Brennan v. Cass County Health, Human

United States Court of Appeals
For the Eighth Circuit
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No. 23-1209
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Catherine Brennan
Plaintiff - Appellant
v.
Cass County Health, Human and Veteran Services; Marsha McMillen, in her
official capacity; Essentia Health St. Joseph’s Medical Center; Essentia Health;
PSJ Acquisition, LLC, doing business as Prairie St. John’s Hospital
Defendants - Appellees
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Appeal from United States District Court
for the District of Minnesota
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Submitted: December 12, 2023
Filed: February 26, 2024
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Before ERICKSON, MELLOY, and STRAS, Circuit Judges.
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ERICKSON, Circuit Judge.
Catherine Brennan commenced this action under 42 U.S.C. § 1983, alleging
federal and state claims arising out of Minnesota civil commitment proceedings.
More specifically, Brennan alleged she was wrongfully committed and unlawfully
forcibly medicated because the defendants failed to recognize she was experiencing

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side effects from psychotropic medications, which were mistaken for psychosis and
mania. Brennan appeals the district court’s1 dismissal of her claims. We affirm.
I. BACKGROUND
In 2014, Brennan took a new job and almost immediately had regrets about
the job change. At an appointment for an allergy shot, Brennan told a nurse
practitioner about the stressful job transition. The nurse practitioner prescribed
Ambien, Prozac, and Ativan. After taking these medications, Brennan asserts she
began experiencing symptoms of akathisia.2 In her amended complaint, Brennan
alleged that before this time she had no history of mental illness and had never taken
psychotropic medications.
From September 2015 through January 2018, Brennan was treated by multiple
providers and hospitalized several times. She was diagnosed with bipolar disorder,
depression, and generalized anxiety disorder. During this timeframe, her medical
records document four suicide attempts, resulting in Brennan twice being committed
as mentally ill. Brennan’s second civil commitment ended on January 24, 2018.
On August 17, 2019, Brennan displayed signs that her mental health was
decompensating. She called 911 three times in one evening, reporting that she was
being threatened by her husband. After the third report, officers arrested Brennan
for making a false 911 report. Two days later, officers received reports that Brennan
was making comments that raised concerns in the City of Pequot Lakes. Several
days later, Brennan’s brother unsuccessfully sought to have Brennan committed.
1 The Honorable Eric C. Tostrud, United States District Judge for the District
of Minnesota.
2 Akathisia is a neuropsychiatric syndrome associated with psychomotor
restlessness. It is a movement disorder that may be associated with the use of
antipsychotic medications. An individual with akathisia may experience an intense
sensation of unease or an inner restlessness usually involving the lower extremities.
https://www.ncbi.nlm.nih.gov/books/NBK519543/ (last visited January 9, 2024).

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The following day, on August 24, 2019, Brennan’s husband called 911 requesting
assistance because Brennan had been making suicidal comments all night. Based on
their observations and interactions with Brennan, responding officers believed
Brennan should be taken to the hospital for an evaluation. When Brennan refused
to get into the ambulance, she was transported by a deputy to the emergency room
at St. Joseph’s Medical Center. The evaluating doctor noted that Brennan was acting
“extremely tangential, paranoid, delusional, agitated and with labile affect,” had
pressured/rapid speech, and was expressing impulsivity along with suicidal ideation.
The doctor signed an emergency hold, noting that Brennan had made suicidal
statements and had a history of mental illness with prior psychiatric admissions.
Brennan was transported that day to Prairie St. John’s Hospital where she was
confined for a month. While at Prairie St. John’s Hospital, Brennan was diagnosed
with bipolar disorder involving current manic episodes with psychotic features;
suicidal ideations; and medication noncompliance.
A petition for commitment was filed in Cass County (Minnesota) state court
on August 28, 2019, by Marsha McMillen, an employee of Cass County Health,
Human and Veterans Services. The petition was supported by a doctor’s statement
diagnosing Brennan with bipolar disorder, unspecified, manic, and indicating
Brennan was currently delusional and confused. The doctor recommended inpatient
treatment. The petition further detailed information contained in progress notes from
Prairie St. John’s Hospital, which demonstrated Brennan continued to struggle with
her mental health even when hospitalized. A preliminary commitment hearing was
held the next day, and the state court ordered Brennan confined pending a final
commitment hearing.
A commitment hearing was held on September 23, 2019, during which
Brennan testified and was represented by court-appointed counsel. Two medical
examiners appointed by the court—the second one at Brennan’s request—testified
via video. After considering the evidence presented, the state court found that
Brennan was a person who met Minnesota’s statutory criteria for civil commitment

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as mentally ill. Brennan was committed for a period of six months. Her commitment
order expired on March 24, 2020.
Brennan chose not to appeal the commitment order or otherwise challenge its
validity. Rather, she commenced this federal action seeking expungement of all
prior commitment-related proceedings, declaratory and injunctive relief, monetary
damages, and attorney’s fees and costs for violations of Minnesota law and her
constitutional rights arising out of the alleged wrongful commitment in 2019 and the
improper administration of neuroleptic medications. Brennan alleged in her
amended complaint that she was first diagnosed with akathisia during her
hospitalizations in late 2015 and early 2016 but she was neither informed of this
diagnosis at the time nor did other treating professionals recognize that she was not
mentally ill but was experiencing adverse reactions to neuroleptic medications.
Brennan also pointed to a letter that Dr. Eric Johnson wrote on July 28, 2022, which
stated that Brennan’s mental condition had been misdiagnosed and she should not
be given antipsychotic medications or mood stabilizers.
The district court granted Marsha McMillen and Cass County Health,
Human and Veteran Services’ motion to dismiss for lack of subject matter
jurisdiction; granted PSJ Acquisition, LLC d/b/a Prairie St. John’s Hospital’s motion
for summary judgment for failure to comply with an expert disclosure requirement
for medical malpractice claims; and granted Essentia Health, St. Joseph’s Medical
Center (the “Essentia defendants), and Prairie St. John’s Hospital’s motions under
Federal Rule of Civil Procedure 12(b)(6) for failure to plausibly allege a claim
against any of the defendants.
II. DISCUSSION
Brennan’s amended complaint alleged three claims: (1) wrongful confinement
arising out of her 2019 civil commitment; (2) invasion of privacy arising out of the
forcible administration of neuroleptic drugs without due process of law; and (3)
medical malpractice. Brennan specifically stated in her opening brief that she is not

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appealing the grant of summary judgment as to the medical malpractice claim
against Prairie St. John’s Hospital. Her position regarding her medical malpractice
claim against the Essentia Health defendants is less clear. Even so, she has waived
any relief as to the district court’s dismissal of her medical malpractice claim against
the Essentia Health defendants by failing to meaningfully argue how the district
court erred in dismissing this claim. See Lawn Managers, Inc. v. Progressive Lawn
Managers, Inc., 959 F.3d 903, 914 n.7 (8th Cir. 2020) (stating a party who does not
meaningfully argue an issue in its opening brief, waives it).
1. Wrongful Commitment
Brennan’s predominant claim in this action is that she was civilly committed
in 2019 in violation of her constitutional rights and Minnesota law. Because
Brennan’s civil commitment order stands, she cannot proceed in this Court with a
wrongful commitment claim. See Heck v. Humphrey, 512 U.S. 477, 486-87 (1994);
Thomas v. Eschen, 928 F.3d 709, 711-713 (8th Cir. 2019).
This Court has determined Heck, which barred claims challenging the validity
of still-valid criminal judgments, applies to constitutional claims challenging a civil
commitment order. Thomas, 928 F.3d at 711-713. Brennan’s attempt to distinguish
Thomas on the ground that she was a patient in a hospital while Thomas was a state
prisoner is a distinction without a difference. The pertinent inquiry turns not on the
status of the person being committed but rather on the nature of the underlying
proceeding. Because Brennan’s state civil commitment order remains valid, we
dismiss her wrongful commitment claim without prejudice. Id.
2. Forcible Administration of Neuroleptic Medications
Brennan next claims the failure to accurately diagnose her medical condition
and forcibly administering neuroleptic medications violated her constitutional rights
and Minnesota law. She alleged the defendants ignored her medical information and
history, injected her with medications that aggravated her existing medical

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condition, ignored her continuous objections, and failed to obtain her consent prior
to the treatment. She contends the defendants, either negligently or intentionally,
disregarded the distinction between a person who is “mentally ill” from a person
having an adverse reaction to neuroleptic drugs.
We review whether a complaint states a cause of action de novo. Buckley v.
Hennepin Cnty., 9 F.4th 757, 760 (8th Cir. 2021). Courts apply the deliberate
indifference standard from the Eighth Amendment when analyzing a civilly
committed individual’s Fourteenth Amendment claim of constitutionally deficient
medical care. Mead v. Palmer, 794 F.3d 932, 936 (8th Cir. 2015) (citation omitted);
see id. at 764 (explaining that the Eighth Amendment deliberate indifference
standard applies when the state restrains an individual’s liberty such that it renders
her unable to care for herself and fails to provide her adequate medical care). This
standard requires a plaintiff to show an objectively serious medical need, which the
defendants knew of, but deliberately disregarded. Mead, 794 F.3d at 936. Deliberate
indifference is “more than negligence, more even than gross negligence, but less
than purposefully causing or knowingly bringing about a substantial risk of serious
harm.” Hall v. Higgins, 77 F.4th 1171, 1179 (8th Cir. 2023) (cleaned up). Whether
a defendant acted with deliberate indifference is measured by the defendant’s
knowledge at the time in question, not by perfect vision of hindsight. Schaub v.
VonWald, 638 F.3d 905, 915 (8th Cir. 2011).
The amended complaint does not plead allegations plausibly showing
deliberate indifference. There are no allegations identifying how Brennan’s care or
treatment exceeded gross negligence. There are no allegations showing which
defendant knew or should have known that Brennan was not suffering from a mental
illness but akathisia. Nor are there allegations that demonstrate when the defendants
knew or should have known that Brennan’s apparent psychiatric problems were the
result of akathisia and not mental illness. Although Brennan has alleged a series of
unfortunate and adverse consequences from the administration of neuroleptic
medications, these allegations are inadequate to show a defendant acted with
deliberate indifference. Given Brennan’s failure to adequately plead deliberate

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indifference as to any of the named defendants, the district court did not err in
dismissing Brennan’s forcible administration of medication claim.
III. CONCLUSION
Because the district court did not err by dismissing Brennan’s wrongful
commitment claim without prejudice or by dismissing her forcible administration of
medication claim with prejudice, we affirm the district court’s judgment.
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