Sheila McCullum v. Kenneth Tepe , 693 F.3d 696 ( 2012 )


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  •                     RECOMMENDED FOR FULL-TEXT PUBLICATION
    Pursuant to Sixth Circuit Rule 206
    File Name: 12a0287p.06
    UNITED STATES COURT OF APPEALS
    FOR THE SIXTH CIRCUIT
    _________________
    X
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    SHEILA MCCULLUM, Individually and as
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    Administratrix of the Estate of Timothy
    Hughes,                                           -
    Plaintiff-Appellee, -
    No. 11-3424
    ,
    >
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    v.
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    -
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    Defendant-Appellant, -
    KENNETH TEPE,
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    BUTLER COUNTY, OHIO; BUTLER COUNTY
    BOARD OF COMMISSIONERS; RICHARD K.                -
    -
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    JONES; LEAH JOHNSON; THERESA DIETZ,
    -
    Sergeant; JANE OR JOHN DOE #1; WILLIAM
    -
    ROGERS; RESOLUTIONS COMMUNITY
    SOLUTIONS, INC.; COMMUNITY BEHAVIORAL             -
    -
    N
    HEALTH, INC.,
    Defendants.
    Appeal from the United States District Court
    for the Southern District of Ohio at Cincinnati.
    No. 1:08-cv-387—Timothy S. Black, District Judge.
    Argued: July 24, 2012
    Decided and Filed: August 28, 2012
    Before: BOGGS, GILMAN, and DONALD, Circuit Judges.
    _________________
    COUNSEL
    ARGUED: David C. Calderhead, CALDERHEAD, LOCKEMEYER & PESCHKE
    LAW OFFICE, Milford, Ohio, for Appellant. Jennifer L. Branch, GERHARDSTEIN
    & BRANCH CO. LPA, Cincinnati, Ohio, for Appellee. ON BRIEF: David C.
    Calderhead, Joshua F. DeBra, Joel L. Peschke, CALDERHEAD, LOCKEMEYER &
    PESCHKE LAW OFFICE, Milford, Ohio, for Appellant. Jennifer L. Branch, Alphonse
    A. Gerhardstein, GERHARDSTEIN & BRANCH CO. LPA, Cincinnati, Ohio, for
    Appellee.
    1
    No. 11-3424           McCullum v. Tepe, et al.                                                 Page 2
    _________________
    OPINION
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    BOGGS, Circuit Judge. Timothy Hughes died after hanging himself from his
    bed in the Butler County Prison. Hughes showed no outward signs that he was suicidal,
    but he did have a history of depression and asked to see Dr. Kenneth Tepe, the prison
    psychiatrist, about anti-depression medication. Hughes and Dr. Tepe never met.
    Hughes’s mother filed this § 1983 suit, alleging that Tepe was deliberately indifferent
    to her son’s serious medical need. Tepe sought summary judgment, arguing that he was
    entitled to qualified immunity. The district court held that Tepe could not assert a
    qualified-immunity defense. We agree. There does not seem to be a history of
    immunity from suit at common law for a privately paid physician working for the public,
    and the policy rationales that support qualified immunity are not so strong as to justify
    our ignoring this history, or lack of history. We therefore affirm the district court’s
    decision denying Tepe’s request for qualified immunity.
    I
    Hughes, incarcerated in the Butler County Prison on charges of robbery,
    contributing to the delinquency of a minor, and abuse of the drugs cocaine and Concerta
    (a drug similar to Ritalin), hanged himself with a bed sheet. He died the next day from
    his injuries. Sheila McCullum, Hughes’s mother, sued, seeking damages against Tepe,
    inter alia.1
    Tepe had provided psychiatric services to inmates of the Butler County Prison
    for approximately ten years. Until 2005, the County paid Tepe directly. At the time of
    Hughes’s suicide, however, Tepe worked for Community Behavioral Health, a non-
    profit entity that provides crisis counseling, mental-health screening and mental-health
    1
    McCullum also sued a social worker who had met with Hughes about his psychiatric needs, the
    non-profit organization that employed both Tepe and the social worker, Butler County, the physician in
    charge of medical services in the prison, and other prison personnel involved in the events that led to
    Hughes’s death.
    No. 11-3424            McCullum v. Tepe, et al.                                                   Page 3
    assessments for Butler County Prison inmates. The Prison’s psychiatric-services
    program, which Tepe designed, had two steps. First, a social worker would conduct
    “triage,” deciding which inmates Tepe should see. Then, if the social worker so
    recommended, the inmate would meet with Tepe in person. Tepe spent approximately
    two hours each Tuesday morning at the Prison, and was on call twenty-four hours a day.
    Hughes arrived at the Prison on March 14, 2007. He told the officer booking him
    that he had attempted suicide within the last year and that, in the past, he had been
    hospitalized for suicidal ideation. Hughes, however, also told the officer that he was not
    currently contemplating suicide. In response, a prison social worker put a suicide alert
    for Hughes in the Prison’s computer system. Ten days later, on March 24, a paramedic
    conducting a routine medical screening noted that Hughes had a history of depression
    and that he had not taken Seroquel, his prescribed medication, in over a year. She
    therefore declined to approve Hughes for a food-service job.                       Nevertheless, the
    paramedic wrote that Hughes had “no medical complaints at this time” and decided not
    to refer him to a doctor.
    On the same day, Hughes filled out an “inmate service request,” asking to “talk
    to Dr. Tepe about geting [sic] back on my Depression and bipolar meds.” Hughes
    elaborated: “I didn’t relize [sic] that when I took my selfe [sic] of [sic] I didn’t need
    them. But now I know I think I need them again.” Social worker Leah Johnson2
    reviewed Hughes’s request on March 27 and spoke to Hughes in person. During their
    conversation, Hughes was “comfortable [and] jovial” and “joked with [Johnson].”
    According to Johnson’s contemporaneous report,3 Hughes explained that he had not
    taken his medication for more than a year, opting instead to medicate himself with
    2
    Johnson is a licensed social worker. Under Ohio law, she cannot diagnose patients, develop
    treatment plans, or provide counseling without clinical supervision by a physician or licensed independent
    social worker. Although both Tepe and licensed-social-worker Chris Connolly—who was also the
    Assistant Vice President of Community Behavioral Health—supervised Johnson, Tepe took responsibility
    for overseeing any decisions she made about medications. Tepe did not review Johnson’s determinations
    that a patient should not see him.
    3
    After Hughes’s suicide, Johnson wrote a more detailed report. For our purposes, detailed
    discussion of this document is not necessary.
    No. 11-3424            McCullum v. Tepe, et al.                                                   Page 4
    marijuana, alcohol, and cocaine.4 Johnson’s report also noted that Hughes did not
    display any psychosis and denied having any suicidal ideation. Johnson declined
    Hughes’s request to see Tepe.
    A number of family members visited Hughes in the days that followed. None
    believed that he was suicidal. On April 6, Hughes had an altercation with his cell-mate.
    He filed charges against the cell-mate, and charges were filed against him. In the
    aftermath of this incident, Hughes met with a sergeant. During that meeting, Hughes
    denied that he was thinking about committing, or planning to commit, suicide.
    The sergeant put Hughes in an isolation cell where, late in the evening, he wrote
    letters to family members. Hughes’s first letter, addressed to his father, expressed anger
    at being “put in the hole” because his cell-mate hit him. “Wats [sic] fucked up the
    most,” Hughes wrote, “is I dident [sic] even set to hit [him] back and they still put me
    in the hole this is bull shit.” Hughes concluded by writing: “I love and miss you so much
    . . . P.S. write back and send pictures please.” The second letter that Hughes wrote was
    to his mother. He asked that she “get that lawyer now” because of the fight, and again
    expressed anger that his cell-mate “hit me and I go to the hole.” In a third letter, also to
    his mother, Hughes wrote: “Thank you and grandma for every thang [sic] you all have
    done and will do for me when I get out. I will need everyones [sic] help to stay off the
    drugs. And stay away from all my old friends that I got them from . . . I cant [sic] wait
    to come home.” Hughes’s last letter was to his grandmother. He apologized for making
    her worry and “promis[ed] to stairtin [sic] my life up when I get out and get a good job.
    And quit doing drugs and stealing.” He concluded: “I love you so much and I wish I
    would have listened to you along [sic] time ago but I could’ent [sic] cause of the drugs.
    And I’m sorry for that . . . P.S. Please write me back. I Love You So much and miss
    you.”
    4
    Johnson’s longer report indicates that, when she told Hughes that he could not immediately get
    Seroquel because he had not been treated by a physician within the last year, he claimed still to be taking
    the drug. Hughes told Johnson that he had been purchasing Seroquel illegally from a friend who had a
    prescription.
    No. 11-3424           McCullum v. Tepe, et al.                                                  Page 5
    The next day, Hughes hanged himself from the side of his bunk with a bedsheet.
    He died the following day, April 8, in the hospital. Hughes did not leave a suicide note.
    Nor did he ever see Tepe.
    McCullum, Hughes’s mother, filed this § 1983 suit against Community
    Behavioral Health, an organization related to Community Behavioral Health called
    Resolutions, and Tepe just under two years later on March 27, 2009.5 She alleged that
    the defendants were liable under § 1983 for deliberate indifference to Hughes’s serious
    medical need, to wit: a suicidal tendency. McCullum also made a wrongful-death claim
    under Ohio law. On December 1, 2010, Tepe moved for summary judgment on
    qualified-immunity grounds and other grounds not relevant here. The district court held
    that Tepe was not entitled to qualified immunity. It first noted that Tepe was not a
    government official automatically entitled to invoke the doctrine. The district court then
    found that Tepe could not claim qualified immunity as a private actor performing a
    government function because he could show neither: (1) a firmly rooted tradition of
    immunity applicable to private defendants like him at common law; nor (2) that the
    purposes underlying the doctrine of qualified immunity supported immunity in his case.
    Tepe appeals.
    II
    Title 
    42 U.S.C. § 1983
     creates a private right of action against “[e]very person
    who, under color of any statute, ordinance, regulation, custom, or usage, of any State or
    Territory . . . subjects, or causes to be subjected, any citizen of the United States . . . to
    the deprivation of any rights, privileges, or immunities secured by the Constitution and
    laws.” Liability, though, is not automatic, even when an official act violates the
    Constitution. “Qualified immunity shields federal and state officials from money
    damages unless a plaintiff pleads facts showing (1) that the official violated a statutory
    or constitutional right, and (2) that the right was ‘clearly established’ at the time of the
    challenged conduct.” Ashcroft v. al-Kidd, 
    131 S. Ct. 2074
    , 2080 (2011). When a district
    5
    On December 9, 2009, the district court consolidated the suit with another suit that McCullum
    had filed earlier against various other Prison personnel involved in the events described above.
    No. 11-3424           McCullum v. Tepe, et al.                                                 Page 6
    court denies qualified immunity, we review its legal conclusions de novo. Grawey v.
    Drury, 
    567 F.3d 302
    , 310 (6th Cir. 2009).6
    The issue in this appeal is whether Tepe, a physician employed by an
    independent non-profit organization, but working part-time for the County as a prison
    psychiatrist, can invoke qualified immunity in a lawsuit arising out of his activities at the
    prison. A physician who contracts to provide medical services to prison inmates, the
    Supreme Court has held, acts under color of state law for purposes of § 1983. West v.
    Atkins, 
    487 U.S. 42
    , 54 (1988). But a party is not entitled to assert qualified immunity
    simply because he is amenable to suit under § 1983. Harrison v. Ash, 
    539 F.3d 510
    , 521
    (6th Cir. 2008).
    Section 1983 “creates a species of tort liability that on its face admits on no
    immunities.” Imbler v. Pachtman, 
    424 U.S. 409
    , 417 (1976). The Supreme Court,
    however, has “accorded certain government officials either absolute or qualified
    immunity from suit if the tradition of immunity was so firmly rooted in the common law
    and was supported by such strong policy reasons that Congress would have specifically
    so provided had it wished to abolish the doctrine.” Wyatt v. Cole, 
    504 U.S. 158
    , 163–64
    (1992) (internal quotation marks omitted). Thus, if a party seeking immunity would
    have been “shielded from tort liability when Congress enacted the Civil Rights Act of
    1871—§ 1 of which is codified at 
    42 U.S.C. § 1983
    —we infer from legislative silence
    that Congress did not intend to abrogate such immunities when it imposed liability for
    actions taken under color of state law.” 
    Id. at 164
    . But even with such an inference, and
    “irrespective of the common law support, we will not recognize an immunity available
    at common law if § 1983’s history or purpose counsel against applying it in § 1983
    actions.” Ibid. Thus, when a private party—including a private person working for the
    government part-time, Filarsky v. Delia, 
    132 S. Ct. 1657
    , 1667–68 (2012)—seeks
    qualified immunity from a § 1983 suit, we determine whether: (1) there was a firmly
    rooted history of immunity for similarly situated parties at common law; and (2) whether
    6
    When reviewing the denial of a motion for qualified immunity, questions of fact are beyond the
    scope of our review. Johnson v. Jones, 
    515 U.S. 304
    , 319–20 (1995). Because the facts relevant to our
    analysis are not in dispute, Johnson has no impact here.
    No. 11-3424            McCullum v. Tepe, et al.                                                   Page 7
    granting immunity would be consistent with the history and purpose of § 1983. See id.
    at 1662 (explaining that, to determine whether a party may assert qualified immunity,
    “we look to the ‘general principles of tort immunities and defenses’ applicable at
    common law, and the reasons we have afforded protection from suit under § 1983”
    (quoting Imbler, 
    424 U.S. at 418
    )); Richardson v. McKnight, 
    521 U.S. 399
    , 404 (1997)
    (noting that, to determine whether prison guards employed by a private corporation were
    entitled to qualified immunity, the Court would “look both to history and to the purposes
    that underlie government employee immunity”).7 We address each question in turn.
    A
    In Richardson, the Supreme Court held that privately employed prison guards
    could not assert qualified immunity. The Court also noted, however, that “[a]pparently
    the [common] law did provide a kind of immunity for certain private defendants, such
    as doctors or lawyers who performed services at the behest of the sovereign.” 
    Id. at 407
    .
    For this proposition, it cited Tower v. Glover, 
    467 U.S. 914
    , 921 (1984), which dealt
    with qualified immunity for public defenders, and Joel Prentiss Bishop, Commentaries
    on Non-Contract Law (1889), which suggested that, at common law, a physician was
    subject to the same immunity rules as a barrister, and that an action for damages could
    not lie against a barrister because his services were considered “honorary.”8 
    Id.
     §§ 704,
    7
    As a recent commentator observed, the Supreme Court has not specified “whether policy and
    history form a conjunctive or disjunctive test, instead leaving their roles uncertain.” Developments in the
    Law—State Action and the Public/Private Distinction, III. Private Party Immunity from Section 1983 Suits,
    
    123 Harv. L. Rev. 1266
    , 1271 (2010). Although Wyatt’s plain language points to a conjunctive test, see
    
    504 U.S. at 164
    , Richardson analyzed policy concerns, even after concluding that “history [did] not
    provide significant support for the [defendants’] immunity claim.” 
    521 U.S. at 407
    ; 
    id.
     at 407–412. We
    follow Richardson out of an abundance of caution. But it may be questionable whether the Supreme
    Court’s jurisprudence in this area would allow a court to extend qualified immunity where there was no
    history of immunity at common law, even if sound policy justified the extension.
    8
    “Professing to follow the example of the Roman Orators, English Barristers and Serjeants did
    not demand compensation, as a matter of right. When they accepted a fee, they did not receive it as an
    equivalent for services rendered, but as a gratuity, or an honorary gift.” Seeley v. Crane, 
    15 N.J.L., 1835
    WL 2033, at *2 (N.J. 1835). Physicians were on the same footing. As Lord Chief Justice Kenyon
    explained in Chorley v. Boclot, (1791) 100 Eng. Rep. 1040, 1041 (K.B.), “it has been understood in this
    country that the fees of a physician are honorary, and not demandable of right; and it is much more for the
    credit and rank of that honourable body.”
    No. 11-3424            McCullum v. Tepe, et al.                                                    Page 8
    708. Neither the Bishop treatise nor the Supreme Court cited any case law suggesting
    that a doctor would have been immune from an action for damages at common law.9
    Soon after Richardson, the Eleventh Circuit decided that a prison
    physician working for a private company could not assert qualified immunity against a
    § 1983 deliberate-indifference claim. Hinson v. Edmond, 
    192 F.3d 1342
    , 1347 (11th Cir.
    1999). “The parties,” the court began, “have not been able to point to, and independent
    research—including a look at the sources cited by the Supreme Court in
    Richardson—does not reveal, cases which show a common law tradition of immunity
    from liability for privately employed prison physicians for acts amounting to
    recklessness or intentional wrongdoing.” 
    Id. at 1345
    . The court, citing Georgia law
    from the mid-Twentieth Century, continued: “Instead, case law shows that even state
    physicians may be subject to liability for intentional torts.” 
    Ibid.
     Similarly, in Jensen
    v. Lane County, 
    222 F.3d 570
    , 577 (9th Cir. 2000), the Ninth Circuit held that a doctor
    accused of wrongfully committing a patient to a mental hospital could not claim
    qualified immunity because there was no common-law history of immunity for such an
    act. Like Hinson, Jensen cited no pre-Twentieth Century case or treatise to support its
    holding, relying instead on Oregon cases and statutes from after 1950.
    We cited both Hinson and Jensen with approval in our published Harrison
    opinion, relying on both for the conclusion “that there is no ‘firmly rooted’ common law
    practice of extending immunity to private [nurses working at a county jail].” 
    539 F.3d at 522
    . Likewise, our unpublished opinion in Cook v. Martin, 148 F. App’x 327, 340–41
    (6th Cir. 2005), relied on Hinson and Jenson to bolster its conclusion that there was no
    firmly rooted tradition of immunity at common law for a private physician’s assistant
    working in a public jail.
    9
    Bishop’s text read: “Probably, within the rule applicable to barristers, [a physician] was not
    liable civilly for the consequences of simple negligence or want of skill; hence the English reports furnish
    us no precedents on our present subject, as to licensed physicians.” Bishop, Commentaries § 708. Bishop
    was mistaken. As the cases cited below illustrate, physicians were held civilly liable in England as early
    as the mid 1300’s.
    No. 11-3424            McCullum v. Tepe, et al.                                                     Page 9
    After Filarsky, however, Hinson and Jenson’s historical analyses—which rested
    on Twentieth Century law—are suspect, at best. Filarsky, 
    132 S. Ct. at 1660
    , addressed
    the question whether an attorney who worked for a city part-time could assert qualified
    immunity. It held that he could. 
    Id. at 1668
    . Although Filarsky dealt with a lawyer, not
    a doctor, it is relevant here because it shows us how to determine whether there was a
    history of immunity for a particular kind of actor at common law. 
    Id.
     at 1662–65.
    Filarsky’s history section focused on the state of the law around the time when Congress
    enacted § 1983. Indeed, the Court did not cite one case decided after 1900 to support
    its historical analysis. And while Filarsky did not impose a rigid date limit, it does
    illustrate the scope of the relevant inquiry: whether a person in the same position as the
    party asserting qualified immunity would have been immune from liability under the
    common law of the late Nineteenth Century. See id. at 1662 (“Under our precedent, the
    inquiry begins with the common law as it existed when Congress passed § 1983 in
    1871.”); Wyatt, 
    504 U.S. at 164
     (“If parties seeking immunity were shielded from tort
    liability when Congress enacted the Civil Rights Act of 1871—§ 1 of which is codified
    at 
    42 U.S.C. § 1983
    —we infer from legislative silence that Congress did not intend to
    abrogate such immunities when it imposed liability for actions taken under color of state
    law.”).
    With this in mind, we consider whether a private doctor working for a state
    institution would have been immune from a suit for damages at common law.10 In
    England, “mala praxis [was] a great misdemesnor [sic] and offence at common law,
    whether it be for curiosity and experiment or by neglect;11 because it breaks the trust
    which the party had placed in his physician, and tends to the patient’s destruction.”
    4 William Blackstone, Commentaries, *122; see also Dr. Groenvelt’s Case, (1697)
    91 Eng. Rep. 1038 (K.B.) (discussing the case a of doctor imprisoned for malpractice);
    Andrew A. Sandor, The History of Professional Liability Suits in the United States,
    10
    Harrison and Cook are not particularly helpful because neither involved a doctor. The former
    involved private nurses; the latter, private physician’s assistants. Furthermore, both relied uncritically on
    cases analyzing law that postdated the passage of § 1983 by seventy-five to one hundred years.
    11
    This observation casts doubt on cases like Hinson that distinguish between a suit against a
    doctor for negligence and a suit against a doctor involving a more culpable mental state.
    No. 11-3424           McCullum v. Tepe, et al.                                                 Page 10
    163 J. Am. Med. Ass’n 459, 459 (1957) (citing English civil medical-malpractice cases
    decided as early as 1374). Bishop is correct that there is little British civil-malpractice
    case law. However, contrary to Bishop’s unsupported speculation, it does not appear
    that doctors generally enjoyed any special kind of immunity. See Sandor, supra, at 459
    (collecting cases).
    The first reported American medical-malpractice case appears to be Cross v.
    Guthery, 
    2 Root 90
    , 
    1794 WL 198
     (Conn. Super. 1794). There, a man retained a doctor
    to perform surgery on a tumor in his wife’s breast. The doctor “promised to perform
    [the] operation with skill and safety to the wife of the plaintiff,” but instead “performed
    said operation in the most unskillful, ignorant and cruel manner, contrary to all the
    well-known rules and principles of practice in such cases; and . . . after said operation,
    the plaintiff’s wife languished for about three hours and then died of the wound given
    by the hand of the defendant.” 
    Id. at *1
    . The plaintiff recovered forty pounds for the
    loss “of the service, company and consortship of his said wife.” 
    Ibid.
     Although the
    doctor defended vigorously, he did not argue that he was immune from damages because
    he was a doctor.
    But the doctor in Cross was a private doctor working for a private client. Tepe
    was a private doctor working for a public institution. Hence, the question: even if
    doctors generally had no immunity at common law, what of a private doctor who, like
    Tepe, worked for the government? There is little directly applicable case law. But the
    precedents that do exist point in one direction: there was no special immunity for a
    doctor working for the state.
    In Landon v. Humphrey, 
    9 Conn. 209
    , 
    1832 WL 76
    , at *1 (Conn. June 1832), a
    doctor contracted with the town of Salisbury to vaccinate residents against “small or kine
    pox.” The doctor, or his agent,12 “so unfaithfully, unskillfully and ignorantly treated the
    plaintiff, that he cut a tendon, cord, ligament and nerve of the plaintiff’s arm and
    inoculated her in an improper, unusual and dangerous place on her arm.” 
    Ibid.
     The
    12
    It appears that the doctor’s agent actually caused the plaintiff’s injury, but the court still
    analyzed the case in terms of the doctor’s lack of due care in administering the vaccination.
    No. 11-3424        McCullum v. Tepe, et al.                                           Page 11
    plaintiff won damages at trial, and the Supreme Court of Errors of Connecticut affirmed.
    The defendant raised a number of objections, but neither he nor the court mentioned
    immunity. Similarly, the Kentucky Court of Appeals—Kentucky’s highest court until
    1976—affirmed a money judgment against a doctor, hired “at the instance of a
    neighboring justice of the peace, acting for the county . . . [and] under instructions to
    give his patient all necessary attention, but not to run the county to unnecessary
    expense.” Williams v. Nally, 
    45 S.W. 874
    , 874 (Ky. Ct. App. 1898). The doctor had
    treated a man with a broken leg, but “because the wound was unskillfully attended to
    . . . gangrene set up in the foot of the patient, and amputation of his leg became
    necessary.” 
    Ibid.
     The doctor defended by arguing that a number of jurors were biased
    and that the plaintiff was responsible for the gangrene because he failed to follow
    instructions. But neither the doctor nor the court mentioned immunity. Last is DuBois
    v. Decker, 
    29 N.E. 313
     (N.Y. 1891). There, a man
    undertook to jump onto an engine of the Ulster and Delaware railroad, in
    the city of Kingston, and in doing so slipped, and his left foot was caught
    by a tender and a portion thereof crushed. Being destitute, he was taken
    to the city alms-house, where he was treated by . . . one of the city
    physicians having the care of the patients therein . . . . Thereafter . . . [the
    physician] amputated the plaintiff’s leg above the ankle joint, and six or
    seven days thereafter, gangrene having set in, he again amputated the leg
    at the knee joint. After the second amputation the leg did not properly
    heal, but became a running sore, and at the time of the trial the bone
    protruded some three or four inches.
    
    Id. at 314
    . The physician defended on a variety of grounds, including the principle that
    a doctor could not be liable for an error in judgment, the lower court’s decision not to
    issue a favorable jury instruction, ibid., and a number of evidentiary decisions at trial,
    
    id. at 315
    . The doctor also asserted that, because he “treated the plaintiff gratuitously,
    he is liable, if at all, only for gross negligence; which was refused.” 
    Ibid.
     The court
    responded:
    It has been held that the fact that a physician or surgeon renders services
    gratuitously does not affect his duty to exercise reasonable and ordinary
    care, skill and diligence.
    No. 11-3424          McCullum v. Tepe, et al.                                          Page 12
    But we do not deem it necessary to consider or determine this question
    for it appears that the plaintiff’s services were not gratuitously rendered.
    He was employed by the city as one of the physicians to attend and treat
    the patients that should be sent to the alms-house. The fact that he was
    paid by the city instead of the plaintiff did not relieve him from the duty
    to exercise ordinary care and skill.
    
    Ibid.
     (emphasis added). This last sentence is suggestive. The doctor in DuBois would
    have had a stronger claim to immunity than Tepe: the city, not a private company, paid
    his wage. Still, the doctor did not raise, and the court did not mention, immunity.
    Rather, the court held that, regardless of who paid the doctor, the standard of care was
    the same, and affirmed a money judgment in favor of the plaintiff.
    These cases, as well as the American and English cases involving private
    physicians in private practice, and the absence of any indicia that a paid physician
    (whether remunerated from the public or private fisc) would have been immune from
    suit at common law, convince us that there was no common-law tradition of immunity
    for a private doctor working for a public institution at the time that Congress passed
    § 1983. The first piece of the Richardson analysis, then, suggests that we should not
    allow Tepe to assert qualified immunity.
    B
    The policy element of our analysis hinges on three of § 1983’s goals:
    (1) “protecting the public from unwarranted timidity on the part of public officials;”
    (2) “ensur[ing] that talented candidates were not deterred by the threat of damages suits
    from entering public service;” Richardson, 
    521 U.S. at 408
    , and (3) guarding against the
    distraction from job duties that lawsuits inevitably create. 
    Id. at 411
    .
    We acknowledge that it is somewhat odd for a government actor to lose the right
    to assert qualified immunity, not because his job changed, but because a private entity,
    rather than the government, issued his paycheck. But just as market pressures, a private
    firm’s ability to “offset any increased employee liability risk with higher pay or extra
    benefits,” ibid., the “continual . . . need for deterring constitutional violations[,] and . . .
    [the] sense that the [private] firm’s tasks are not enormously different in respect to their
    No. 11-3424        McCullum v. Tepe, et al.                                      Page 13
    importance from various other publicly important tasks carried out by private firms,” 
    id. at 412
    , vitiated any policy-based concerns in Richardson, these same factors suggest that
    immunity would be inappropriate here. And, even if we could create an immunity not
    recognized at common law based on policy alone, see supra note 7, we would not do so
    here.
    III
    Despite the Supreme Court’s somewhat cryptic comment in Richardson
    that a doctor may have had immunity from damages at common law, there does not
    appear to be any history of immunity for a private doctor working for the government,
    and the policies that animate our qualified-immunity cases do not justify our creating an
    immunity unknown to the common law. Thus, although we express no opinion on the
    ultimate validity of McCullum’s claims, we AFFIRM the district court’s conclusion that
    Tepe is not entitled to assert qualified immunity.