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    Ziccardi v. Philadelphia
    PRECEDENTIAL
    
           Filed April 30, 2002
    
    UNITED STATES COURT OF APPEALS
    FOR THE THIRD CIRCUIT
    
    No. 01-1895
    
    *JOSEPH ZICCARDI, ESQ., as
    ADMINISTRATOR OF THE ESTATE OF JAMES SMITH
    
    v.
    
    CITY OF PHILADELPHIA;
    ROGER MORFITT; JOSEPH
    DIFRANCESCA
    
    Joseph DiFrancesca and
    Roger Morfitt,
    
           Appellants
    
    *(Amended -- See Court's Order dated 3/14/02)
    
    ON APPEAL FROM THE
    UNITED STATES DISTRICT COURT
    FOR THE EASTERN DISTRICT OF PENNSYLVANIA
    
    District Court Judge: Honorable Mary A. McLaughlin
    (D.C. No. 99-cv-05484)
    
    Argued: January 15, 2002
    
    Before: ALITO and ROTH, Circuit Judges, and
    SCHWARZER,* Senior District Judge.
    
    (Opinion Filed: April 30, 2002)
    _________________________________________________________________
    
    * The Honorable William W Schwarzer, Senior District Judge for the
    Northern District of California, sitting by designation.
    
    
    
    
           RICHARD G. FEDER (Argued)
           Chief Deputy City Solicitor (Appeals)
           SARA E. RICKS
           1515 Arch Street, 17th Floor
           Philadelphia, PA 19102
    
           Counsel for Appellants
    
           EDWARD T. LAWLOR, Jr. (Argued)
           297 S. Newtown Street Road
           Newtown Square, PA 19073
    
           LEONARD A. COHEN
           2401 Pennsylvania Avenue,
            Suite 1C-51
           Philadelphia, PA 19130
    
           Counsel for Appellee
    
    OPINION OF THE COURT
    
    ALITO, Circuit Judge:
    
    This is an appeal from a district court order denying a
    motion for summary judgment based on qualified immunity
    in an action under 42 U.S.C. S 1983. The action was filed
    by James Smith, now deceased, against two Philadelphia
    Fire Department paramedics and the city. Smith alleged
    that the paramedics rendered him a quadriplegic by lifting
    him after he had fallen from a wall and sustained spinal
    injury. He claimed that the actions of the paramedics
    violated his rights under the Due Process Clause of the
    Fourteenth Amendment. The district court held that the
    summary judgment record was sufficient to show that the
    paramedics acted with subjective deliberate indifference
    and therefore denied their summary judgment motion. To
    the extent that this appeal raises issues of law, we affirm
    the decision of the district court. To the extent that the
    appeal disputes the district court's identification of the
    facts that are subject to genuine dispute, we dismiss the
    appeal for lack of appellate jurisdiction.
    
                                    2
    
    
    I.
    
    In the early morning hours of May 16, 1998, after a night
    of drinking, James Smith, then 24 years old, went to his
    aunt's residence in Philadelphia, where he often stayed.
    App. at 5a. He was not able to enter the house because he
    did not have a key and no one responded to his knocks on
    the door. Id. He therefore sat down on the wall in front of
    the house and eventually fell asleep. Id. He apparently fell
    from the wall and dropped about eight feet to the sidewalk
    below. Id. After Smith fell, several neighbors heard him
    groaning and yelling, but by all accounts he was moving his
    legs and arms. Id.
    
    Joseph DiFrancesca and Roger Morfitt ("the appellants"),
    Philadelphia Fire Department paramedics, responded to a
    911 call placed by a neighbor. According to Maceo
    Gatewood, a neighbor, the following then occurred. When
    the paramedics approached Smith, they asked him what
    his name was and what was wrong. Supp. App. at 5b. He
    said: "I'm hurt. I hurt my head." Id. Smith repeated several
    times that he had hurt his neck.2 App. at 144a-45a. One of
    the paramedics said: "[G]et up. Are you drunk?" and "[G]et
    up or we're going to call the police." Id. at 182a-83a. Smith
    responded, "I can't get up." Id. at 183a. After nudging
    Smith a few times and again asking him to get up, the
    paramedics each grabbed one of Smith's arms and
    "snatched him up and threw each arm over their shoulders
    and dr[agged] him to the . . . stretcher," which they had
    removed from the ambulance and placed in the street. Id.
    at 183a-84a. Gatewood said that the paramedics "snatched
    up" Smith "pretty hard" and that after they did so his head
    jerked back. Id. at 185a. In Gatewood's words, Smith "sort
    of got real limp after that, like everything started hanging
    on him," and he did not move his arms or legs thereafter.
    Id.
    _________________________________________________________________
    
    2. Gatewood said that these remarks were made"after the ambulance got
    there," App. at 144a, but the defendants assert that the record does not
    show whether these alleged remarks were made when the paramedics
    were within earshot. Appellants' Br. at 5 n.1. The defendants also note
    that neither Smith nor Roberta Brown, who was on the scene, recounted
    these remarks.
    
                                    3
    
    
    Another neighbor, Roberta Brown, gave the following
    account. She said that when the paramedics arrived at the
    scene, she told them that Smith was called "Man," and they
    said: "[G]et up, Man. Get up before we call the police.
    You're only drunk, get up." App. at 186a. Smith responded:
    "I'm hurt." Id. at 187a. The paramedics then each took one
    of his arms and "yanked him up." Id. In Brown's words,
    Smith then "started hollering, `Miss Burt, Miss Burt, tell
    them to put me down. I can't move.' And they yanked him
    up and his head went back." Id. at 186a-87a. The
    paramedics then got the stretcher; one lifted his feet and
    the other lifted the upper part of his body, and they put
    him on the stretcher and took him away. Id. at 187a.
    
    Smith recounted what happened as follows. When the
    paramedics arrived, he was on his stomach, and they told
    him to get up. App. at 83a-84a. He replied: "I can't get up."
    Id. at 85a. They then said: "Get up before we call the cops
    on you." Id. Smith responded: "I can't move. I can't get up."
    Id. at 86a. The paramedics then rolled him on his back,
    each paramedic grabbed an arm, and they "pulled" or
    "yanked" him up. Id. As they pulled him up, his neck
    "snapped back." Id. at 87a. In Smith's words, "it was like
    somebody hit a light switch and [he] just went completely
    numb" below the neck. Id. at 87a-88a. The paramedics
    then laid him down, got the stretcher, put him on the
    stretcher, and transported him to a hospital. Id . at 88a-
    89a.
    
    When Smith reached the hospital, the doctors recognized
    the seriousness of his condition and stabilized his neck by
    putting him in a hard collar and placing him on a board.
    App. at 208a. He was diagnosed with permanent
    quadriplegia. Id. at 7a. A physician who treated Smith at
    the hospital stated:
    
           It is a medical certainty that [the paramedics] should
           have immobilized his cervical spine prior to moving
           him. To have, instead, lifted him by his arms and then
           by his shoulders and legs is unconscionable. It is my
           opinion within a reasonable degree of medical
           certainty, that Mr. Smith's quadriplegia is directly
           attributable to the actions of the paramedics.
    
                                    4
    
    
    Id. at 213a.
    
    Dr. Stephan Lynn, an expert in emergency medical
    services, reviewed the records and opined that the
    paramedics "demonstrated incredible and shockingly
    deliberate indifference to Mr. James Smith and to his needs
    as an injured person seeking ambulance assistance." App.
    at 225a.
    
    In October 1999, Smith filed a complaint in the Court of
    Common Pleas of Philadelphia County, asserting due
    process claims against the two paramedics and the city.
    The complaint alleged that the paramedics' actions in lifting
    him improperly had deprived him of his liberty interest in
    bodily integrity. The complaint also alleged that the
    paramedics' conduct was in accordance with an established
    city custom of treatment toward intoxicated individuals and
    that the paramedics' conduct resulted from the city's failure
    to provide proper training despite prior instances of
    mistreatment.
    
    The defendants removed the case to the United States
    District Court for the Eastern District of Pennsylvania and,
    after discovery, moved for summary judgment. The
    individual defendants asserted the defense of qualified
    immunity, but the district court refused to grant summary
    judgment on that ground. The court held that "a reasonable
    jury could find that the defendant paramedics acted with
    deliberate indifference and in a manner that shocks the
    conscience in injuring the plaintiff." Dist. Ct. Op. at 2. The
    district court also concluded that "clearly established law at
    the time of the incident provided sufficient guidance to the
    defendants about the unconstitutionality of their conduct."
    Id. In addition, the court denied the city's request for
    summary judgment because that request was based solely
    on the contention that no underlying due process violation
    could be established. Id. The individual defendants then
    took this appeal.3
    _________________________________________________________________
    
    3. While the appeal was pending, Smith died, and Joseph Ziccardi, Esq.,
    the administrator of his estate, was substituted as the plaintiff.
    
                                    5
    
    
    II.
    
    On appeal, the appellants first contend that the district
    court applied the wrong legal standard in denying their
    summary judgment motion. They argue that, "[a]t an
    absolute minimum," the plaintiff was required to show that
    they had "actual knowledge" that he had suffered a serious
    spinal injury and that they nevertheless moved him"with
    actual deliberate indifference to his safety." Appellants' Br.
    at 10. The appellants also contend that even proof of
    "actual deliberate indifference" may not suffice and that,
    under our decision in Miller v. City of Philadelphia, 174
    F.3d 368 (3d Cir. 1999), "a state of mind that approaches
    an `an intent to harm' plaintiff is required to prove a
    constitutional violation in the instant context." Id. at 13.
    
    The appellants maintain that we have jurisdiction to
    consider both of their arguments under the collateral order
    doctrine first recognized in Cohen v. Beneficial Industrial
    Loan Corp., 337 U.S. 541 (1949), but they read the relevant
    precedents too broadly. In Mitchell v. Forsyth , 472 U.S. 511
    (1985), the Supreme Court held that "a district court's
    denial of a claim of qualified immunity, to the extent that it
    turns on an issue of law, is an appealable `final decision' "
    under the collateral order doctrine. Id. at 530 (emphasis
    added). In Johnson v. Jones, 515 U.S. 304 (1995), the Court
    made it clear that the collateral order doctrine does not
    permit an appeal from an order denying a motion for
    summary judgment if the issue raised is "whether or not
    the evidence in the pretrial record [is] sufficient to show a
    genuine issue of fact for trial." Id. at 307.
    
    Johnson involved an action under 42 U.S.C.S 1983
    against five police officers for use of excessive force in
    effecting an arrest. Id. Three of the officers moved for
    summary judgment, arguing that there was insufficient
    evidence in the summary judgment record to permit a
    reasonable finder of fact to find that they were present
    when the plaintiff was beaten. Id. The district court denied
    this motion, concluding that there was enough evidence to
    defeat summary judgment. Id. at 308. The officers appealed
    and invoked the collateral order doctrine, but the Supreme
    Court unanimously held that appellate jurisdiction was
    lacking. Id. The Court held that Mitchell does not authorize
    
                                    6
    
    
    an appeal from an order denying summary judgment if the
    order, "though entered in a `qualified immunity' case,
    determines only a question of `evidence sufficiency,' i.e.,
    which facts a party may, or may not, be able to prove at
    trial." Id. at 313. As we understand Johnson, if a defendant
    in a constitutional tort case moves for summary judgment
    based on qualified immunity and the district court denies
    the motion, we lack jurisdiction to consider whether the
    district court correctly identified the set of facts that the
    summary judgment record is sufficient to prove; but we
    possess jurisdiction to review whether the set of facts
    identified by the district court is sufficient to establish a
    violation of a clearly established constitutional right.4 See
    Eddy v. Virgin Islands Water & Power Auth., 256 F.3d 204,
    208 (3d Cir. 2001).
    
    The appellants urge us to read Johnson to apply only to
    evidentiary questions regarding conduct as opposed to
    intent. Relying chiefly on Jeffers v. Gomez, 267 F.3d 895,
    907-10 (9th Cir. 2001), they argue that Johnson  permits us
    to entertain a collateral order appeal that challenges a
    district court's decision denying summary judgment on the
    ground that there is a genuine issue of fact as to whether
    the defendant acted with the intent required by the
    particular constitutional claim asserted. We cannot agree.
    In our view, Johnson clearly applies to factual disputes
    about intent, as well as conduct.
    
    First, we see nothing in the Johnson Court's reasoning
    that supports a distinction between issues of conduct and
    issues of intent. Referring to the requirement of the
    collateral order doctrine that an appeal must present an
    issue completely separate from the merits of the case,
    Johnson observed that "[w]here . . . a defendant simply
    _________________________________________________________________
    
    4. We reject the appellants' suggestion that Saucier v. Katz, 533 U.S. 194
    (2001), somehow narrowed Johnson. Saucier never referred to Johnson
    and said nothing whatsoever about appellate jurisdiction. Nor do we read
    Brown v. Armenti, 247 F.3d 69 (3d Cir. 2001), as supporting appellants'
    position. In Brown, we quoted Behrens v. Pelletier, 516 U.S. 299, 313
    (1996), stating that Johnson held "that determinations of evidentiary
    sufficiency at summary judgment are not immediately appealable merely
    because they happen to arise in a qualified-immunity case." 247 F.3d at
    77.
    
                                    7
    
    
    wants to appeal a district court's determination that the
    evidence is sufficient to permit a particular finding of fact
    after trial, it will often prove difficult to find any such
    `separate' question -- one that is significantly different from
    the fact-related legal issues that likely underlie the
    plaintiff 's claim on the merits." Johnson , 515 U.S. at 314.
    This reasoning applies equally to questions regarding proof
    of conduct and proof of intent. The latter are no more
    separable from the merits of the case than the former.
    
    The Johnson Court also noted that "the existence, or
    nonexistence, of a triable issue of fact [ ] is the kind of issue
    that trial judges, not appellate judges, confront almost
    daily," and the Court added that "[i]nstitutionally speaking,
    appellate judges enjoy no comparative expertise in such
    matters." Id. at 316. Again, this reasoning applies equally
    to questions regarding conduct and intent.
    
    Finally, Johnson reasoned that "the close connection
    between [the kind of issue raised in the case before it] and
    the factual matter that will likely surface at trial means
    that the appellate court, in the many instances in which it
    upholds a district court's decision denying summary
    judgment, may well be faced with approximately the same
    factual issue again, after trial, with just enough change
    brought about by the trial testimony to require it, once
    again, to canvass the record." Id. at 316-17. This, the Court
    observed, would result in an "unwise use of appellate
    courts' time." Id. at 317. These observations, too, seem
    equally applicable to issues of conduct and intent. Thus,
    the reasoning of Johnson lends no support to the
    appellants' proffered distinction between conduct and
    intent.
    
    Second, at least one passage in Johnson refers directly to
    questions of intent and suggests that the Court specifically
    contemplated that its decision would not allow interlocutory
    appeals regarding the sufficiency of the evidence of intent.
    The Court wrote:
    
           [Q]uestions about whether or not a record
           demonstrates a `genuine' issue of fact for trial, if
           appealable, can consume inordinate amounts of
           appellate time. Many constitutional tort cases , unlike
    
                                    8
    
    
           the simple `we didn't do it' case before us, involve
           factual controversies about, for example, intent--
           controversies that, before trial, may seem nebulous. To
           resolve these controversies -- to determine whether
           there is or is not a triable issue of fact about such a
           matter -- may require reading a vast pretrial record,
           with numerous conflicting affidavits, depositions, and
           other discovery materials.
    
    Id. at 316 (emphasis added). We thus reject the appellants'
    reading of Johnson.
    
    III.
    
    With this understanding of the scope of our appellate
    jurisdiction in mind, we address the specific arguments
    raised by the appellants. As noted, the appellants' first
    argument is that, at an absolute minimum, the plaintiff is
    required to show that they acted with subjective deliberate
    indifference and that the district court did not apply this
    standard. This is a question of law, and it is therefore
    properly before us, but we reject the argument on the
    merits for the simple reason that the district court did
    apply the subjective indifference standard. The district
    court wrote:
    
           Most courts have held that the deliberate indifference
           standard requires a showing of "subjective deliberate
           indifference" . . . . A subjective standard would require
           that the defendants actually knew of Smith's injuries.
           The record reveals sufficient facts from which a
           reasonable jury could find that the defendants inferred
           that Smith was seriously injured.
    
    Dist. Ct. Op. at 18-19. After recounting some of what the
    neighbors had said, the court concluded:
    
           Whether DiFrancesca and Morfitt actually did draw the
           inference that Smith was seriously injured from these
           facts is an issue for a jury to decide. The Court finds
           that a reasonable fact-finder would be able to find that
           the paramedics had actual knowledge of the fact that
           Smith was seriously injured.
    
                                    9
    
    
    Id. at 20. The appellants' argument that the district court
    did not apply the "subjective deliberate indifference" test is
    thus entirely without merit.
    
    The real thrust of the appellants' argument appears to be
    that the summary judgment record is insufficient to prove
    that they acted with subjective deliberate indifference. Since
    the district court held to the contrary, they reason that the
    court must not in fact have applied the right legal standard.
    The appellants state that, while the district court's opinion
    contains language "purporting to apply . . . the . . .
    subjective test of actual knowledge, the district court in
    reality applied a reasonable-person objective, negligence-
    like standard." Appellants' Br. at 10. The appellants'
    argument is an attempt to circumvent Johnson by
    disguising what is in truth an evidentiary argument as a
    legal argument. The disguise is transparent, and we
    dismiss the appellants' appeal to the extent that it presses
    this evidentiary issue.
    
    IV.
    
    A.
    
    The appellants' remaining argument is that even
    "subjective deliberate indifference" is not enough. In the
    district court, the appellants argued that the plaintiff was
    required to prove that they acted with an actual intent to
    harm him. See Dist. Ct. Op. at 9. The appellants' briefs on
    appeal did not advance this argument, and at oral
    argument, however, counsel for the appellants specifically
    stated, in response to a question, that he was not arguing
    that an actual intent to harm is needed. Instead, the
    appellants have fallen back on the position that something
    more than subjective deliberate indifference but less than
    actual intent to harm is required. Relying on a phrase in
    Miller, they contend that the requisite intent is "gross
    negligence or arbitrariness that indeed `shocks the
    conscience.' " Miller, 174 F.3d at 375-76. The question
    whether something more than subjective deliberate
    indifference must be shown in this case is a legal question
    that we may entertain in this appeal.
    
                                    10
    
    
    B.
    
    The intent needed to support a substantive due process
    claim is a question that has long troubled our court. See,
    e.g., Davidson v. O'Lone, 752 F.2d 817 (3d Cir. 1984) (en
    banc), aff 'd, 474 U.S. 344 (1986); Fagan v. City of
    Vineland, 22 F.3d 1283 (3d Cir. 1994) (en banc); Nicini v.
    Morra, 212 F.3d 798 (3d Cir. 2000) (en banc). The Supreme
    Court most recently discussed this issue in City of
    Sacramento v. Lewis, 523 U.S. 833 (1998), a police chase
    case. After noting that " `[t]he touchstone of due process is
    protection of the individual against arbitrary action of
    government," id. at 845 (quoting Wolf v. McDonnell, 418
    U.S. 539, 558 (1974)), the Court added that "the cognizable
    level of executive abuse of power" is "that which shocks the
    conscience." Id. at 846. The Court stated that "conduct
    intended to injure in some way unjustifiable by any
    government interest is the sort of official action most likely
    to rise to the conscience-shocking level." Id . at 849. The
    Court acknowledged that it had held that "deliberate
    indifference," as opposed to an intent to harm, was
    sufficient in one context, medical treatment of pretrial
    detainees. Id. at 849-50. In that situation, the Court
    observed, deliberation about the proper course of conduct
    "is not only feasible but obligatory under a regime that
    incapacitates a prisoner to exercise ordinary responsibility
    for his own welfare." Id. at 851. The Court contrasted "the
    custodial prison situation" with a police chase. Id. at 853.
    The Court stressed that a police officer, in deciding whether
    to begin or break off a chase, does not have time to
    deliberate and must balance the risks of a chase against
    the risks of permitting the suspect to escape. Id. The Court
    therefore held that in a police chase case an actual intent
    to harm must be shown. Id. at 854.
    
    We have applied Lewis in several subsequent cases. In
    Miller, on which the appellants rely, a mother and her
    children claimed that a social worker violated their
    substantive due process rights by taking actions that led to
    an emergency ex parte order removing the children from the
    mother's custody due to suspected child abuse. Miller, 174
    F.3d at 370-71. Noting that "a social worker acting to
    separate parent and child . . . rarely will have the luxury of
    
                                    11
    
    
    proceeding in a deliberate fashion," we held that"the
    standard of culpability for substantive due process
    purposes must exceed both negligence and deliberate
    indifference, and reach a level of gross negligence or
    arbitrariness that indeed `shocks the conscience.' " Id. at
    375-76.
    
    In Nicini v. Morra, 212 F.3d 798 (3d Cir. 2000), we
    considered a substantive due process claim asserted by a
    minor against a caseworker from the New Jersey Division of
    Youth and Family Services based on the minor's abuse in
    what we viewed as tantamount to a foster home. Id. at 800.
    We analogized the situation of a minor placed in a foster
    home with that of an institutionalized person and noted
    that the caseworker had time to make unhurried judgments
    in deciding whether to permit the minor to remain in the
    home. Id. at 807. We thus distinguished Miller and held
    that a standard of deliberate indifference was appropriate.
    Id. at 810-11.
    
    C.
    
    The appellants' current argument -- that Smith is
    required to prove something more than subjective deliberate
    indifference but less than an intent to harm -- was never
    raised in the district court. Instead, the appellants argued
    in the district court that an intent to harm is needed. They
    maintained that the intent-to-harm standard adopted in
    Lewis should apply and stated: "Paramedics are similarly
    situated to pursuing police officers and their actions should
    be held to the same consci[ence] shocking standard. They
    make decisions in haste, under pressure, and without the
    luxury of a second chance." App. at 262a. Although the
    appellants cited and briefly discussed Miller  in their papers,
    they never mentioned that the standard applied in Miller
    required less than an intent to injure, and they never
    argued -- even as a back-up argument -- that this lesser
    standard should be applied. See App. at 263a.
    
    We generally do not address arguments that were not
    made in the district court and we therefore decline to
    consider the appellants' current argument as a ground for
    reversing the decision of the district court. See Bailey v.
    
                                    12
    
    
    United Airlines, 279 F.3d 194, 202 (3d Cir. 2002); Brown v.
    Philip Morris, Inc., 250 F.3d 789, 799 (3d Cir. 2001).
    However, because it would be inefficient for us to remand
    this case to the district court without clarifying whether
    Miller requires proof of more than subjective deliberate
    indifference, we will address that question.
    
    We agree with the appellants that Miller, which is of
    course binding on us, mandates at least something more
    than subjective deliberate indifference as that term is
    defined in Farmer v. Brennan, 511 U.S. 825 (1994).5 Miller
    is important here for at least two reasons. First, the lead
    plaintiff in Miller (the mother) -- like Smith in this case and
    unlike the plaintiff in Nicini -- was not in a situation
    analogous to institutionalization, but the court nevertheless
    held that an actual intent to harm was not needed to
    support the due process claim. Miller, 174 F.3d at 375-76.
    Second, Miller's reason for holding that more than
    deliberate indifference had to be shown -- the social
    worker's need to act without "the luxury of proceeding in a
    deliberate fashion," id. at 375 -- seems equally applicable
    here. While the record in the present case does not suggest
    that the appellants had any particular need to move Smith
    quickly -- for example, he was not in a dangerous location
    and did not appear to have any other medical problems
    requiring prompt movement -- the social worker in Miller
    similarly does not appear to have had a need to make a
    split-second decision. What the Miller court seems to have
    had in mind was the need for the social worker to act in a
    matter of hours or minutes. Nevertheless, the Miller court
    held that the nature of the situation faced by the social
    worker mandated proof of something more than subjective
    deliberate indifference, and this holding seems to require
    the application of a similar standard here.
    
    We must thus attempt to determine exactly what Miller
    required. The appellants have seized upon the phrase"a
    _________________________________________________________________
    
    5. In Kneipp v. Tedder, 95 F.3d 1199 (3d Cir. 1996), which preceded
    Lewis, we held that deliberate indifference sufficed in a case in which
    state actors placed the plaintiff in a dangerous situation and the plaintiff
    was harmed by a nongovernmental actor. The case before us is not a
    "state created danger" case and is not governed by Kneipp.
    
                                    13
    
    
    level of gross negligence or arbitrariness that indeed
    `shocks the conscience.' " Id. at 375-76. The Miller court
    used this phrase as one part of its explanation of the
    ground for affirming a grant of summary judgment for the
    social worker, and we do not think that the phrase was
    intended as a precise articulation of the governing legal
    standard.6
    
    So what did Miller require? We can approach an answer
    by noting what Miller did not demand. As noted, Miller
    expressly stated that the defendant social worker need not
    have acted with the purpose of causing the relevant harm,
    namely, removal of the children without good cause. Id. at
    375. Nor did Miller suggest that the defendant had to have
    known that this harm was practically certain to result.7 On
    the other hand, Miller demanded something more than
    deliberate indifference, which requires (in the sense
    applicable here) that a person consciously disregard"a
    substantial risk of serious harm." Farmer, 511 U.S. at 836.
    Miller thus appears to have demanded proof of something
    less than knowledge that the harm was practically certain
    but more than knowledge that there was a substantial risk
    that the harm would occur. A simple way of putting this is
    that Miller mandated proof that the defendant was aware of
    more than a substantial risk -- let us say a great risk --
    that there was no good cause for the removal of the
    children.
    
    This reading of Miller is supported by Miller's discussion
    of Croft v. Westmoreland County Children & Youth Services,
    103 F.3d 1123 (3d Cir. 1997), in which parents were told
    _________________________________________________________________
    
    6. The phrase is not well suited for that purpose. "[A]rbitrariness" is a
    general requirement for a substantive due process violation, see Lewis,
    523 U.S. at 846, not a specification of a precise degree of intent. And
    "gross negligence" is a lower level of intent than even tort-law
    recklessness, which is, in turn, lower than criminal-law recklessness or
    subjective deliberate indifference. Id. at 849.
    
    7. Compare Model Penal Code S 2.02(2)(b) (a person acts "knowingly" with
    respect to a result if the person is aware that the result is "practically
    certain" to occur). In Farmer v. Brennan, 511 U.S. 825, 839 (1994), the
    Supreme Court referred to the Model Penal Code's definition of
    recklessness, and therefore reference to the Model Penal Code's carefully
    constructed categorization of intent is appropriate here.
    
                                    14
    
    
    that their daughter would be immediately removed from the
    home and placed in foster care unless the father left the
    home and avoided any contact with the daughter while an
    investigation was conducted to determine whether he was
    sexually abusing her. Id. at 1124. Noting that the defendant
    social worker in that case had no evidence of abuse except
    an anonymous tip based on hearsay and that the social
    worker had not even formed an opinion as to whether
    abuse had occurred, the Croft court held that the plaintiff
    parents and child had adduced sufficient evidence to
    establish a substantive due process violation. Id. at 1127.
    The court stressed that the defendant caseworker's conduct
    was "arbitrary" and completely without reasonable
    evidentiary support. Id. As the court stated in Miller:
    
           [T]he social worker was acting solely on the basis of a
           sixth-level hearsay statement and had not personally
           formed an opinion as to whether abuse was likely.
           Breaking the parent-child bond under these
           circumstances, we held, was an arbitrary abuse of
           government power.
    
    Miller, 174 F.3d at 375. Another way of putting the same
    point is that the social worker, in ordering the father's
    removal, consciously disregarded a great risk that there
    had been no abuse.
    
    In summary, then, we understand Miller to require in a
    case such as the one before us, proof that the defendants
    consciously disregarded, not just a substantial risk, but a
    great risk that serious harm would result if, knowing Smith
    was seriously injured, they moved Smith without support
    for his back and neck. On remand in the present case, we
    believe that the district court should apply this standard
    and instruct the jury accordingly if one is empaneled.
    
    V.
    
    For the reasons explained above, this appeal is dismissed
    in part, and the order of the district court denying the
    appellants' motion for summary judgment is affirmed.
    
                                    15
    
    
    A True Copy:
    Teste:
    
           Clerk of the United States Court of Appeals
           for the Third Circuit
    
                                    16
    

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