State v. Patrick McLeod Nissley

Citations: 241 Ariz. 327; 387 P.3d 1256; 2017 WL 430072; 2017 Ariz. LEXIS 24Docket: CR-15-0393-PR

Court: Arizona Supreme Court; February 1, 2017; Arizona; State Supreme Court

Original Court Document: View Document

SummaryOriginalCytator Case TreatmentBackward CitatorAnalysis

EnglishEspañolSimplified EnglishEspañol Fácil

A law enforcement officer generally needs a search warrant to obtain an involuntary blood sample from a suspect. However, Arizona law includes a medical blood draw exception, allowing medical personnel to provide a portion of a blood sample when there is probable cause to believe the individual was driving under the influence, provided the sample was drawn for medical reasons and exigent circumstances exist. The court addressed whether this exception applies when a suspect claims that medical treatment was administered against their will. It determined that the state must demonstrate that the suspect either consented to medical treatment or that the treatment occurred while the suspect was incapable of making decisions regarding their care.

In the case of Patrick Nissley, he drove erratically, causing a crash that resulted in injuries and a fatality. Despite his uncooperative behavior and demands to be left alone, paramedics concluded he was unable to make coherent decisions and restrained him for treatment. After being sedated at the hospital, a police officer obtained a blood sample without a warrant, which tested positive for methamphetamine and heroin metabolites. Nissley was subsequently indicted on multiple charges, including second-degree murder.

Nissley sought to suppress the results of his blood test, arguing that the absence of a warrant or valid exception to the warrant requirement invalidated the test. He claimed the medical blood draw exception did not apply since he was treated against his will. The trial court held an evidentiary hearing and denied the motion, concluding Nissley did not explicitly refuse treatment, thus allowing the exception. A jury convicted him of reckless manslaughter and other charges, leading to sentencing. The court of appeals affirmed the decision in a split ruling.

The Supreme Court of Arizona reviewed the case to clarify the medical blood draw exception, acknowledging its significance statewide. The court has jurisdiction based on the Arizona Constitution and state law. The standard for reviewing a suppression motion is for abuse of discretion, with deference given to factual findings supported by the record but a de novo review of legal determinations. The medical blood draw exception under A.R.S. § 28-1388(E) allows law enforcement to obtain a blood sample if there is probable cause to believe a person violated DUI laws.

The court referenced the precedent set in Cocio, which established that warrantless blood draws are permissible if probable cause, exigent circumstances, and medical personnel involvement are present. However, it disavowed the notion that the natural dissipation of alcohol in the bloodstream automatically constitutes a per se exigency for warrantless blood tests, as reaffirmed by the U.S. Supreme Court in Missouri v. McNeely. The court emphasized that exigency must be evaluated based on the specific circumstances of each case and that future cases will require the state to prove exigency was impractical to establish through obtaining a warrant.

The Fourth Amendment prohibits unreasonable searches and seizures, establishing that warrantless searches are generally unreasonable unless an exception applies, such as the medical blood draw exception. In this case, state action occurred when medical personnel complied with an officer's request for a blood sample, which was compelled by Arizona statute 28-1388(E) under threat of prosecution. This compulsion invokes Fourth Amendment protections, paralleling federal precedent that recognizes the influence of sovereign authority on compliance. Additionally, individuals have a constitutional right to direct their medical treatment and to refuse unwanted medical intervention under the Fourteenth Amendment.

The court has not previously determined the applicability of the medical blood draw exception when a suspect refuses treatment. Previous rulings in State v. Estrada and State v. Spencer concluded that the exception applies only when medical treatment is voluntarily received. However, these cases have led to confusion regarding the state's burden of proof in invoking the exception. Estrada emphasized that a refusal of treatment precludes forced compliance for blood draws, while Spencer required the state to prove that consent was freely given. This discrepancy has created uncertainty over whether the state must show a suspect did not clearly refuse treatment or that they voluntarily consented. The appellate court in the current case adopted the earlier standard from Estrada, while dissenting opinions leaned towards the standard set in Spencer.

Nissley and Amicus contend that the courts incorrectly placed the burden on Nissley to demonstrate an explicit and unambiguous rejection of medical treatment. The appellate court found this argument sufficiently raised, dismissing the State's waiver claim. Importantly, neither court contested that the State bore the burden of proving lawful acquisition of the blood sample. The State must establish that Nissley did not clearly refuse medical treatment, drawing parallels to the requirement for proving voluntary consent for blood draws under the Fourth Amendment.

Nissley and Amicus argue that just as the State must prove consent for blood draws, it must also prove consent for medical treatment to invoke the medical blood draw exception. The State asserts that this standard is not constitutionally mandated and could hinder law enforcement's ability to act in emergencies when a defendant cannot consent. The analysis begins with the individual's right to control their medical treatment, which requires the capacity to make informed decisions. This right is not absolute and may be limited by state interests, such as preserving life and protecting third parties.

Determining whether a constitutional violation has occurred involves balancing the individual's liberty interests against state interests. The State must demonstrate, in addition to probable cause and exigency, that blood samples obtained under the medical treatment exception complied with the defendant's rights regarding medical decisions. The burden of proof lies with the prosecutor, as per Arizona Rule of Criminal Procedure 16.2(b). Generally, unless the defendant is incapable of providing consent, the State must show that consent was freely given, either explicitly or implicitly. Courts should evaluate the totality of circumstances, including any indication from the defendant regarding their willingness to accept treatment. Implied consent can arise from actions like seeking treatment. However, in emergencies where consent cannot be obtained, medical personnel may act if the risk of not treating outweighs potential harm from the treatment.

In cases where a patient is unable to consent and requires immediate medical attention, it is generally assumed that consent can be implied. Nissley contests the use of the medical blood draw exception for defendants who are unconscious or incapable of consenting. However, when both probable cause and exigent circumstances are present, law enforcement is permitted to conduct a warrantless blood draw under the unconscious exception as outlined in A.R.S. 28-1321(C). Probable cause must exist to believe the defendant is intoxicated, and law enforcement must reasonably perceive an emergency situation where obtaining a warrant would risk the destruction of evidence. 

Law enforcement may obtain part of a blood sample drawn for medical reasons, which is less intrusive than conducting a separate blood draw. The court acknowledges the relevance of medical battery cases concerning a person's right to direct their treatment but maintains that both Fourth Amendment rights and the right to medical decision-making are pertinent in this context. To apply the medical blood draw exception in this case, the state must demonstrate: (1) probable cause of DUI, (2) exigent circumstances preventing a warrant, (3) that the blood was drawn for medical purposes by qualified personnel, and (4) that the medical treatment provided did not infringe upon the suspect's right to direct their own care. 

The court vacates the prior appellate decision, noting insufficient evidence to determine Nissley’s ability to direct his medical treatment or whether that right was violated. The case is remanded to the trial court to assess whether law enforcement lawfully obtained the blood sample; if not, Nissley’s convictions and sentences will be vacated, the blood alcohol evidence suppressed, and a new trial ordered.