As we continue building a working command of the constitutional standards governing use of force, we now turn to a critical area for patrol officers, supervisors, and command staff: medical care obligations, restraint practices, and positional asphyxia risks. These cases define when force becomes excessive during restraint, when officers must intervene to prevent medical deterioration, and how courts evaluate compressional force, prone positioning, and detainee vulnerability.

Unlike pursuit cases, which fall primarily under the Fourth Amendment, medical care and restraint cases often involve Fourteenth Amendment due process protections for pretrial detainees and Eighth Amendment protections for convicted prisoners. The constitutional minimum requires that officers avoid deliberate indifference to serious medical needs and refrain from force that is objectively unreasonable in light of known risks-especially asphyxia.

I have included some non-United States Supreme Court cases this week, as these cases are the source of a great deal litigation and liability.  As always, with Supreme Court cases, remember that state law, state constitutions, and agency policy may be more restrictive. Many departments now prohibit or severely limit prone restraint, compressional force, and certain control techniques due to well‑documented medical risks. Policies often require immediate repositioning, continuous monitoring, and rapid medical evaluation-particularly when a subject is handcuffed, intoxicated, mentally ill, or exhibiting signs of medical distress.

This series is not ranked or ordered by importance. As has been stated, every case matters. Every case is foundational. A summary is provided here, but officers and supervisors should read the full opinions to understand the facts, reasoning, and holdings.

Understanding these rulings is essential for patrol officers, field training officers, supervisors, and command staff responsible for use‑of‑force review, restraint policy development, and in‑custody death prevention.

26. City of Revere v. Massachusetts General Hospital, 463 U.S. 239 (1983)

Fact Pattern: Police shot and injured a fleeing suspect. Officers transported him for medical treatment, and the hospital later sought payment. The issue before the Court was not the shooting itself, but whether the city had a constitutional obligation to provide medical care to an injured arrestee.

Rule: Officers must ensure that injured arrestees receive necessary medical care. The Fourteenth Amendment requires access to treatment; who ultimately pays the bill is a secondary, non‑constitutional issue.

Why It Matters: Revere establishes the foundational rule that medical care is mandatory, not optional. Once a person is injured during an arrest-whether by force, accident, or self‑harm-officers must secure treatment. Failure to do so can constitute unconstitutional conduct. This case underpins modern duty‑to‑render‑aid policies and reinforces that medical neglect can create significant civil liability.

27. Tolan v. Cotton, 572 U.S. 650 (2014)

Fact Pattern: A young man was shot by police during a mistaken‑identity encounter. At summary judgment, the lower courts accepted the officers’ version of events and discounted conflicting evidence offered by the plaintiff.

Rule: Courts must view disputed facts in the light most favorable to the plaintiff at the summary judgment stage. Judges may not weigh evidence or resolve factual disputes prematurely.

Why It Matters: Tolan is not a medical‑care case, but it is essential in all use‑of‑force litigation. It prevents early dismissal when facts are contested and ensures that juries-not judges (unless the case proceeds to a bench trial)-resolve factual disputes. For officers and supervisors, Tolan reinforces the importance of accurate reporting, consistent articulation, and objective evidence (video, witness statements, medical findings) because courts will scrutinize discrepancies closely.

28. Weigel v. Broad, 544 F.3d 1143 (10th Cir. 2007)

Fact Pattern: Weigel had been in an accident with police.  Upon investigation, he was suspected of driving under the influence and then fought with the officers .  Police restrained him prone on the ground for an extended period while applying body weight. The subject stopped breathing and died. The officers sought qualified immunity, arguing the risks were not clearly established.

Rule: Prolonged prone restraint with body weight, when officers know or should know of asphyxia risks, can violate clearly established law. Qualified immunity was denied.

Why It Matters: While this is not a United States Supreme Court case, Weigel is one of the most influential restraint‑related cases in the country. It recognizes the well‑known dangers of positional asphyxia and holds officers accountable for ignoring those risks. This case has shaped national restraint policies, including requirements to avoid extended prone positioning, remove body weight quickly, and monitor breathing. It is widely cited beyond the Tenth Circuit and remains a cornerstone of in‑custody death litigation.

29. Estate of Booker v. Gomez, 745 F.3d 405 (10th Cir. 2014)

Fact Pattern: A detainee in a jail setting was restrained prone while officers applied body weight, pressure, and a Taser. The detainee became unresponsive and later died. The court evaluated whether the officers were on notice that their actions created a substantial risk of asphyxia.

Rule: Using body weight on a prone, restrained detainee, especially when the subject is no longer resisting, violates clearly established law. Officers were on notice of the medical dangers associated with compressional force.

Why It Matters: This is another non-United States Supreme Court case, but Booker strengthens detainee protections and reinforces that asphyxia risks were clearly established well before many modern incidents. The case also highlights training failures, emphasizing that agencies must educate officers on medical risks, monitoring responsibilities, and the need to reposition subjects promptly. Booker is frequently cited in cases involving jail restraint, Taser use, and in‑custody death investigations.

30. Drummond v. City of Anaheim, 343 F.3d 1052 (9th Cir. 2003)

Fact Pattern: Officers responded to a mentally ill subject experiencing a crisis. After handcuffing him, they continued applying body weight to his back and neck while he lay prone and compliant. The subject repeatedly stated he could not breathe and later suffered severe injuries.

Rule: Applying compressional force to a prone, restrained, compliant subject is excessive when officers know or should know of the risk of impaired breathing.

Why It Matters: This is yet another non-United States Supreme Court case.  That said, Drummond is one of the leading positional‑asphyxia cases in the United States. It clearly establishes that continued pressure on a prone subject, especially after compliance, is unconstitutional. The case is widely used in training to illustrate the dangers of compressional force, the importance of repositioning, and the need to recognize medical distress. Drummond remains a foundational restraint‑related precedent in the Ninth Circuit and beyond.

Parting Thoughts (Part Six)

These five cases define the constitutional limits of force, restraint, and medical care during police encounters. They clarify:

• That officers must ensure medical care for injured arrestees
• That courts must view disputed facts in the plaintiff’s favor at summary judgment
• That prolonged prone restraint and compressional force carry known asphyxia risks
• That officers are on notice regarding the dangers of body‑weight pressure
• That continued force on compliant, restrained subjects is unconstitutional

For supervisors and command staff, the operational takeaway is clear: medical care, monitoring, and safe restraint practices are non‑negotiable. Agencies must train officers to recognize medical distress, avoid compressional force, reposition promptly, and document their actions thoroughly. These cases shape restraint policies, in‑custody death prevention strategies, and post‑incident review for every agency engaged in custodial operations.

The next article (cases 31–35) will examine Training, Policy, and Municipal Liability—an essential area for command‑level leadership and agency risk management.