[DO NOT PUBLISH]
IN THE UNITED STATES COURT OF APPEALS
FOR THE ELEVENTH CIRCUIT FILED
U.S. COURT OF APPEALS
ELEVENTH CIRCUIT
December 21, 2006
THOMAS K. KAHN
No. 05-16973 CLERK
D. C. Docket No. 03-00337-CV-WDO-5
VALENCIA GARY,
Plaintiff-Appellant,
versus
JERRY MODENA, Individually and as
Sheriff Bibb County, Georgia,
JACK CLEVELAND, et al.
Defendants-Appellees.
Appeal from the United States District Court
for the Middle District of Georgia
(December 21, 2006)
Before BIRCH, PRYOR and FAY, Circuit Judges.
FAY, Circuit Judge:
This appeal challenges a summary judgment order in a 42 U.S.C. § 1983
action involving the death of a pre-trial detainee. One day after police officers
booked Jerry Butts into the Bibb County Law Enforcement Center ("LEC") for
violating probation, he died of acute heart failure. Thereafter, the administrator of
Butts' estate, his daughter Valencia Gary, sued various custodians and medical
care-givers at the Bibb County LEC in both their individual and official capacities
for deliberate indifference to Butts' medical needs. 1 Gary's complaint alleged that
the defendants violated Butts' constitutional rights under the Eighth and
Fourteenth Amendments by withholding essential medical care. The defendants
moved for summary judgment and the district court granted their motion. For the
reasons set forth below, we affirm that portion of the order granting summary
judgment to defendants Modena, Hilliard, Nelson, Gunnels, Boatwright, Joiner,
Mosely, Collins, PHS and Bibb County and reverse that portion granting summary
judgment to defendants Cleveland, Lawrence, Driskell, Minton, White and Davis.2
1
Gary's original complaint joined plaintiff Annie Pearl Reed, who asserted related state law
claims for wrongful death and medical malpractice as Butts' mother. The district court declined to
exercise supplemental jurisdiction over plaintiffs' state law claims after it ruled on the 42 U.S.C. §
1983 claim and dismissed the state law claims without prejudice. Plaintiff Reed does not join Gary
in this appeal, nor does Gary challenge the district court's decision to dismiss plaintiffs' state law
claims. Thus, we need not review that portion of the district court decision here.
2
Sheriff Jerry Modena's last name appears as "Modina" throughout Gary's original pleading,
her motions and her appellate briefs. Similarly, Nurse Rosemarie Davis' first name appears as
"Rosemary" throughout Gary's pleadings and briefs, and in defendant's answers and briefs. deputy
Billy Boatwright's last name appears as "Boatright" in the district court order awarding him summary
2
Before we proceed with our review, we note two considerations that will
structure our analysis of plaintiff-appellant's 42 U.S.C. § 1983 claim. First, we
note that Gary's claim involves two different groups of defendants. One group had
direct contact with Butts and ministerial responsibility to monitor him while he
was in detention; another group, which includes Bibb County, a governmental
entity, had no direct contact with Butts, but exercised supervisory control over
those who did, and set policies on inmate care and screening, which dictated how
Butts' more immediate custodians should act. Since 42 U.S.C. § 1983 applies a
different standard of liability for supervisory officials and governmental entities
we will discuss these two groups of defendants - the custodial or ministerial
defendants and the supervisory defendants - separately.
Additionally, we note that Gary has agreed to dismiss her claim against
several of the supervisory defendants; namely, Bibb County Sheriff's deputies
Nelson, Gunnels, Boatwright, and Joiner in her Response to Defendants' Motion
for Summary Judgment and has omitted defendant Mosely's name from the list of
remaining defendants. (R.101-4). Thus, we need not review the district court order
awarding summary judgment to this particular group of defendants in any further
judgment. We use the spellings that these defendants provided in their depositions, notwithstanding
the alternate spellings that appear elsewhere in the record.
3
detail than to note the court entered its decision on this group with Gary's
agreement, and we affirm its order accordingly.
I. BACKGROUND
The undisputed facts of the case are these. Agents of the Middle Georgia
Fugitive Squad arrested fifty-five year old Jerry Butts at his home on the morning
of October 16, 2001 for violating probation after they found that he was keeping a
weapon with an altered serial number in his house. The arresting officers
transported Butts to the Bibb County LEC for booking at approximately 10:00
a.m., where Sheriff's deputy Ray Hilliard filled out a preliminary medical
questionnaire on Butts at 10:25 a.m. to initiate the booking process. Hilliard noted
that Butts was on medication, suffered from chest pains, and had received
treatment previously for both a heart condition and high blood pressure.
Nurse Sandra White, an L.P.N. employed by the Bibb County Sheriff's
Office, received Butts' screening form sometime that same afternoon and
prioritized him for follow-up screening because he had reported past treatment for
a heart condition and high blood pressure. She attempted, but ultimately failed to
conduct the follow-up screening before the end of her shift at 4:00 p.m.
In the interim, Butts' sister, Marcia Mathis, and his companion, Mary Lou
Rhodes, came by the LEC to see whether they could drop medication off for him.
4
Mathis asked officers in the public lobby of the LEC whether they would accept
Butts' medication if she went by his house to retrieve it. She was informed that
they could not accept outside medicine in such situations and that they had nurses
who were responsible for assessing inmates and supplying necessary medications
to them.
Later that evening, at 6:10 p.m., Butts signed a sick call request form,
complaining of severely swollen ankles and feet. At 7:00 p.m. Sheriff's deputies
Jerry Minton and Antonio Driskell arrived to assume the evening shift watch over
Butts' cell block. Minton and Driskell performed a series of block checks during
their shift, visiting each cell to verify the head count on inmates at 7:00 p.m.,
12:00 a.m., 2:00 a.m. and once more at 6:00 a.m. After each of these block checks
they jotted the figure "10-4" down in their logbooks to indicate that they
encountered no problems during their block checks.
At 7:00 a.m. on the 17th of October, as Sheriff's deputies Harry Lawrence
and Jack Cleveland arrived to take over guard duties for the day shift, they found
Butts lying on the floor between his cell and the glass-walled control booth where
Minton and Driskell stood guard. Lawrence walked past Butts without saying
anything to him. Cleveland, who came in several minutes after Lawrence,
attempted to talk to Butts, but could not get him to respond. Butts only mumbled
5
incomprehensibly. An inmate helped Butts back to his bunk. Deputy Cleveland
checked on Butts later that morning at 10:00 a.m. and found him still
unresponsive.
At 2:00 p.m. Nurse Rosemarie Davis, an R.N. employed by PHS, received
Butts' sick call request from the previous evening. She took no action on the
request. Approximately one hour later, around 2:54 p.m. Butts collapsed in his cell
at the LEC and paramedics rushed him to the emergency room at the Medical
Center for Central Georgia. Doctors pronounced him dead at 3:50 p.m. from acute
heart failure.
Thereafter, Butts' daughter Valencia Gary, who was serving as the
administrator for his estate, filed a deliberate indifference claim pursuant to 42
U.S.C. § 1983 in the U.S. District Court for the Middle District of Georgia,
naming Bibb County, PHS, the Bibb County Sheriff, the PHS director, and the
deputies and medical personnel who were on duty during Butts' detention as
defendants, in both their individual and official capacities. Annie Pearl Reed,
Butts' mother, joined Gary as a plaintiff in the suit, adding several state law
negligence claims for wrongful death and medical malpractice to the federal
claims.
The defendants moved to dismiss, asserting that they were entitled to
6
qualified immunity. The district court withheld a decision on their motion pending
additional discovery. The defendants filed a subsequent motion for summary
judgment and the district court granted this motion, dismissing the plaintiffs'
remaining state law claims without prejudice, and dismissing the motion that was
pending on the qualified immunity issue as moot. Gary filed the instant appeal to
challenge the summary judgment order on Butts' 42 U.S.C. § 1983 claim.
II. STANDARD OF REVIEW
We review the district court's ruling on a motion for summary judgment de
novo, and adhere to the same legal standards that bound the district court. National
Fire Insur. Co. of Hartford v. Fortune Const. Co., 320 F.3d 1260, 1267 (11th Cir.
2003), cert. denied, 540 U.S. 873, 124 S.Ct. 221, 157 L.Ed.2d 133 (2003). See
Sarfati v. Wood Holly Assocs., 874 F.2d 1523, 1525 (11th Cir. 1989); Carlin
Communication Inc. v. Southern Bell Tel. & Tel. Co., 802 F.2d 1352, 1356 (11th
Cir. 1986).
Rule 56(c) of the Federal Rules of Civil Procedure provides that a district
court should grant summary judgment if the record, including pleadings,
depositions, answers to interrogatories, admissions on file, and affidavits, fails to
disclose any genuine issue of material fact and the moving party is entitled to
judgment as a matter of law. FED. R. CIV. P. 56(c); National Fire Insur. Co., 320
7
F.3d at 1267. The moving party bears the initial burden of proving that no genuine
issue of material fact exists. Celotex Corp. v. Catrett, 477 U.S. 317, 323, 106 S.Ct.
2548, 2553, 91 L.Ed.2d 265, 274 (1986). As we review the record on a motion of
summary judgment, we draw all reasonable inferences that the record permits and
evaluate those inferences in the light most favorable to the non-moving party.
Whatley v. CNA Ins. Cos., 189 F.3d 1310, 1313 (11th Cir. 1999).
III. DISCUSSION
A. Deliberate Indifference Under 42 U.S.C. § 1983
Title 42 U.S.C. § 1983 (2006) provides that:
"Every person who, under color of any statute, ordinance, regulation,
custom or usage, of any State or Territory or the District of Columbia,
subjects or causes to be subjected, any citizen of the United States or
other person within the jurisdiction thereof to the deprivation of any
right, privileges or immunities secured by the Constitution and laws,
shall be liable to the party injured in an action at law, suit in equity or
other proper proceeding for redress."
Gary alleges that the defendants, who served as public officials of Bibb
County, the Bibb County Sheriff's Office and / or PHS, violated Jerry Butts'
Eighth and / or Fourteenth Amendment rights by denying him access to necessary
medications and by failing to complete a medical screening of him when he
presented obvious signs of a serious medical condition. Since Butts was a pre-trial
8
detainee at the time of alleged violations, Gary's deliberate indifference claims fall
under the due process clause of the Fourteenth Amendment and not the cruel and
unusual punishment prohibition of the Eight Amendment. Ingraham v. Wright,
430 U.S. 651, 671 n.40, 97 S.Ct. 1401, 1412, 51 L.Ed.2d 711, 730 (1977);
McDowell v. Brown, 392 F.3d 1283, 1290 n.8 (11th Cir. 2004), Cottone v. Jenne,
326 F.3d 1352, 1357 (11th Cir. 2003).
Nevertheless, due process requires that prison officials provide all persons
in state custody such basic human needs as medical care, regardless of whether the
persons have been incarcerated or are being held in detention. See Hamm v.
DeKalb County, 774 F.2d 1567, 1574 (11th Cir. 1985) (holding that "in regard to
providing pretrial detainees with such basic necessities as ... medical care[,] the
minimum standard allowed by the due process clause is the same as that allowed
by the eighth amendment for convicted persons); see also Cottone, 326 F.3d 1352,
1357, citing Marsh, 268 F.3d at 1024 n.5. Accordingly, we look to the Eighth
Amendment's deliberate indifference standards when analyzing Gary's 42 U.S.C.
§1983 claim. McDowell, 392 F.3d at 1290 n.8.
A prison official may be held liable under the Eighth Amendment for
denying an inmate humane conditions of confinement "only if he knows that
inmates face a substantial risk of serious harm and disregards that risk by failing to
9
take reasonable measures to abate it." Farmer v. Brennan, 511 U.S. 825, 847,114
S.Ct. 1970, 1984, 128 L.Ed.2d 811, 832 (1994). To demonstrate that a prison
official acted with deliberate indifference to an inmate's medical needs, a plaintiff
must provide evidence that the inmate presented an objectively serious medical
need and that the official ignored it. Farrow v. West, 320 F.3d 1235, 1243 (11th
Cir. 2003).
We have defined a serious medical need as one that is "so obvious that even
a lay person would easily recognize the necessity for a doctor's attention." Id. at
1243 (quoting Hill v. DeKalb Reg'l Youth Det. Ctr., 40 F.3d 1176, 1187 (11th Cir.
1994)). Additionally, a plaintiff who alleges a deliberate indifference claim against
a prison official must show that the official's alleged unconstitutional acts caused
his injury. Marsh, 268 F.3d at 1028.
To determine whether an independent contractor such as a prison physician
has acted under color of law for the purposes of § 1983 liability, a court will look
to the medical provider's function within the state system rather than the precise
details of his employment status. West v. Atkins, 487 U.S. 42, 55-56, 108 S.Ct.
2250, 2258-2259, 101 L.Ed.2d 40, 53-54 (1988). A prison physician who
furnishes medical services to state prison inmates as part of his contractual duties
to that state acts under color of state law for the purposes of § 1983. Id. (holding
10
that a private physician under contract to the State of North Carolina was acting
under color of state law when he treated an inmate's injury and that the state could
be held liable for his deliberate indifference).
B. Liability of Supervisory Defendants for Deliberate Indifference
This circuit has repeatedly held that 42 U.S.C. § 1983 does not allow
plaintiffs to hold supervisory officials liable for the actions of their subordinates
under either a theory of respondeat superior or vicarious liability. Hartley v.
Parnell, 193 F.3d 1263, 1269 (11th Cir. 1999), citing Belcher v. City of Foley, 30
F.3d 1390, 1396 (11th Cir. 1994); Gonzalez v. Reno, 325 F.3d 1228, 1234 (11th
Cir. 2003) (concluding that supervisory officials are not liable on the basis of
respondeat superior or vicarious liability); Cottone, 326 F.3d at 1360. Supervisory
liability under § 1983 attaches only when the supervisor personally participates in
the allegedly unconstitutional acts of his subordinates or where the actions of the
supervising official bear a causal relationship to the alleged constitutional
deprivation. Gonzalez, 325 F.3d at 1234; Braddy v. Florida Dep't of Labor &
Empl. Sec., 133 F.3d 797, 802 (11th Cir.1998), citing Brown v. Crawford, 906
F.2d 667, 671 (11th Cir. 1990).
A plaintiff can establish a causal relationship between a supervisory
official's acts and the acts of his subordinates if he shows that: (1) the supervisor
11
had notice of a widespread history of abuse which he neglected to correct,
Gonzales, 325 F.3d at 1234, citing Braddy, 133 F.3d at 802; Cottone, 326 F.3d at
1360; (2) the supervisor implemented a custom or policy that resulted in deliberate
indifference to constitutional rights, Gonzales, 325 F.3d at 1234-1235, citing
Rivas v. Freeman, 940 F.2d 1491, 1495 (11th Cir. 1991); Cottone, 326 F.3d at
1360; or (3) the facts support "the inference that the supervisor directed the
subordinates to act unlawfully or knew that the subordinates would act unlawfully
and failed to stop them from doing so." Gonzalez, 325 F.3d at 1235; See Post v.
City of Fort Lauderdale, 7 F.3d 1552, 1561 (11th Cir. 1993) (finding no
supervisory liability in the absence of such an inference).
In the case before us, Gary names Sheriff Jerry Modena of the Bibb County
Sheriff's Office, Bibb County, Georgia, a governmental entity, PHS, a private
medical provider under contract to Bibb County, and PHS Doctor Robert Collins
as supervisory defendants. We begin by examining the evidence against Sheriff
Modena. Gary does not allege that Modena personally participated in the alleged
unconstitutional conduct that led to Butts' death. Rather, she alleges that Modena's
policies promoted deliberate indifference by his subordinates because he allowed
untrained deputies to perform medical screenings as part of the booking process,
and failed to implement adequate policies on when and how LEC officers might
12
accept delivery of medications from an inmate's family.
Additionally, Gary alleges that Modena was on notice of the Infirmary's
concerns about Nurse White's competence and that he not only failed to correct the
situation, but ordered Nurse White reassigned to the Infirmary over the objections
of her PHS supervisor, Vickie Irvine. After consideration of the record, we affirm
the order granting summary judgment to Sheriff Jerry Modena because Gary fails
to establish the necessary causal connection between Modena's policies and the
alleged unconstitutional conduct of Modena's subordinates. See Gonzalez, 325
F.3d at 1234; Braddy, 133 F.3d at 802.
Gary has not alleged any facts that show how Modena's policy of
authorizing booking officers to collect preliminary medical histories on incoming
inmates and screen them for outwardly visible injuries could have caused Butts'
death. The record indicates that Butts reviewed his Receiving/Screening form after
his booking officer, Deputy Ray Hilliard, completed it, and that Butts attested to
its accuracy by signing the form. Butts did not note any omissions himself, and
Gary does not allege that he was unable to read or understand what he was signing
in this instance.
Nevertheless, Gary argues that Butts presented chest pains coupled with
swollen feet and ankles at Booking, and that these facts should have alerted a
13
properly trained Booking officer to the possibility of congestive heart failure.
There is no evidence in the record, however, to suggest that Butts presented these
symptoms.
The medical screening form set forth the following question on chest pains.
"Do you suffer from...chest pains...?" and provided a Yes/No answer choice in a
column alongside it. Hilliard noted that Butts responded "Yes" to this question.
Gary alleges that Butts was suffering from chest pains while he was at Booking,
and that Hilliard failed to note the immediacy of Butts' complaint. She doesn't cite
any evidence to support this allegation, however. It is simply a bald allegation.
With respect to the question of whether Butts presented visibly swollen feet at
Booking, Gary does offer some evidence to suggest that Butts' feet were swollen
on the morning of his arrest. Yet, the question of whether the swelling persisted
several hours later when Butts went through Booking remains open.
Butts' mother testified that he was walking around in his socks when she
saw him early on the morning of his arrest because his feet were too swollen to fit
into shoes. Other testimony by Butts' mother and his companion suggests that he
may well have taken his medication before his arrest, raising the possibility that
his symptoms could have abated somewhat by the time that deputy Hilliard saw
him. Absent evidence to indicate that Butts arrived at Booking without his shoes,
14
we have no basis for inferring that Hilliard omitted any pertinent facts about
swelling in Butts' extremities.
After Hilliard completed the screening form, the record shows that he
placed the form into an Infirmary basket so that PHS nurses could review it and
determine the needs for any follow-up medical screening. There is no evidence to
suggest that Hilliard failed to submit the form in a timely fashion. Contrary to
Gary's allegations, the policy of allowing deputies to fill out a preliminary medical
questionnaire for PHS actually appears to have achieved the desired effect in this
case. It alerted Nurse White to Butts' health risks; White testified that she
immediately prioritized Butts for follow-up screening on the basis of the
information that Hilliard collected. Thus, Hilliard highlighted the sort of
information that Infirmary nurses needed in order to identify Butts as someone
who should receive follow-up screening by medical personnel.
Gary also failed to allege specific facts that would show how Modena's
policy on the receipt of outside medications caused Butts' death. LEC policy on
the receipt of outside medicine dictated that Infirmary nurses should be called
when family members of inmates presented medications. Gary does not allege that
the policy promoted deliberate indifference, or that Modena, directed his
subordinates to violate the policy or knew that they would and failed to stop them.
15
Instead, she alleges that he failed to take corrective measures when subordinates
violated the policy.
The record does furnish testimony that the policy was not always followed
consistently. Nurse Davis testified that she heard complaints from time to time that
guards did not notify nurses that family members had come by with medications.
A pattern of inconsistent compliance in separate cases does not establish a causal
connection between Modena's policy and Butts' death, however. The standards for
establishing causality dictate that the pattern of abuse must have been widespread
and that the supervisor must have been put on notice about it and failed to correct
it. Gonzalez, 325 F.3d at 1234, citing Braddy, 133 F.3d at 802.
Moreover, the record does not indicate that Butts' family members actually
presented his medication to guards or that Butts' death occurred because guards
spurned his family's attempts to deliver his medication on the 16th. Butts' sister
testified under deposition that she asked the officers in the service area of the LEC
whether she could retrieve Butts' medications from his home and drop them off,
but that she did not approach the guards with Butts' medication in hand. The
record indicates that she is the only family member who actually spoke to the
guards directly. Although Gary presented the testimony of a medical expert who
concluded that Butts would almost certainly have lived if he had received his
16
medications on the 16th, the record suggests that Butts may well have taken his
prescribed medications on the morning of his arrest.
Butts' mother gave testimony that she visited his home on the morning of
his arrest and asked him whether he had taken his medicine. She testified that he
brushed her off with a laugh and assured her that he was taking it. Butts'
companion also testified that she believed he had taken his medication that
morning before his arrest. Accordingly, Gary has not shown that Modena's policy
prevented family members from leaving medication for Butts or that he absolutely
required delivery of medication on the afternoon of the 16th because he had not
been able to take it beforehand. Gary fails to establish the guards' actions as the
proximate cause of Butts' injury.
Finally, with respect to Nurse White's alleged unconstitutional acts, Gary
has not presented evidence that White had a widespread pattern of failing to
complete inmate screenings and that Modena had notice of her problems in this
area. The record does indicate that Vickie Irvine, who supervised White's work in
the Infirmary, disciplined White for excessive use of sick leave and asked to have
White removed from the Infirmary and relieved of all duties for patient care in
April 2001 because she was staggering, slurring her words, and having trouble
with her train of thought. Irvine attributed White's problems to the prescription
17
medicines that she was taking at the time. Modena had notice of Irvine's concerns
that White's problems could compromise patient care, and he complied with
Irvine's request, giving White work assignments in other areas of the LEC for
several months.
Eventually, he ordered White back to work in the Infirmary, however.
According to Irvine's testimony, she reassigned White to screening at this point,
giving her a fairly simple task that did not involve actual patient care. Irvine
testified that she never disciplined White for failing to complete a screening or
heard a complaint about White's ability to perform a screening, which ordinarily
only took a few minutes. If White's immediate superior had no notice that White
would fail to complete a follow-up screening, Modena could scarcely have been
put on notice of White's potential for misconduct on screenings. Thus, Gary has
failed to establish a causal connection between Modena's supervisory acts and
White's alleged unconstitutional acts.
We consider Gary's claim against Doctor Robert Collins of PHS next. Gary
does not allege that Collins personally participated in the unconstitutional conduct
that led to Butts' death, rather she alleges that he endorsed the policy of allowing
non-medical personnel to conduct preliminary screenings for PHS and this policy
promoted deliberate indifference. Gary also alleges that Collins had supervisory
18
control over Nurse White because he served as the director of the Infirmary at the
LEC, and that he failed to monitor White's job performance, although he knew that
the Infirmary's health care administrator had asked to have White removed from
her duties for patient care.
As a threshold matter, we note that neither Hilliard, the Booking officer who
conducted Butts' preliminary screening, nor White, the Infirmary nurse who failed
to follow-through on that preliminary screening, answered to Collins. They were
subordinates of the Bibb County Sheriff's Office. Sheriff Modena, not Doctor
Collins, had final decision-making authority for the LEC policy that allowed
Booking officers to screen inmates for obvious medical problems. Gary argues on
appeal that Collins did have authority as the Infirmary's medical director to relate
subordinates' concerns about inadequacies of the screening process to PHS and he
failed to do so. Gary contends that Irvine, the Infirmary's health administrator,
opposed the process of using deputies for preliminary screening and that she
conveyed her concerns to Collins, but he failed to take them forward to PHS.
While Irvine did testify that she felt the preliminary screening process
would proceed more efficiently if medical personnel conducted the screenings
from the outset, and that she discussed her suggestion with the Sheriff's Office, she
did not testify that she told Collins she opposed the practice because it could
19
compromise inmate care. Nor did Irvine allude to any sort of chronic problem with
the intakes that Booking officers provided to the Infirmary, apart from noting that
the deputies sometimes misspelled the names of medications, requiring that nurses
do additional research.
Thus, Gary does not point to any facts in the record that show either Irvine
or Collins were on notice of unconstitutional conduct in the performance of
screenings, and thereby, fails to establish a causal connection between Collins'
supervision of the Infirmary and the specific constitutional violation alleged here,
which involves Booking officer Hilliard.
With respect to Gary's allegation that Collins' policy on Nurse White
promoted deliberate indifference, Gary fails to articulate what that particular
policy was. Gary argues that Collins knew Irvine had relieved White of her patient
care duties at the Infirmary and that he failed to have a meeting with Sheriff
Modena or Infirmary administrator Irvine to discuss White's job performance after
this. Gary does not argue that Collins attempted to block Irvine from taking
disciplinary actions against White or that he reassigned White to the Infirmary
over Irvine's objections, however.
Thus, Gary does not show that Collins implemented any particular policy
that would have sanctioned White's alleged misconduct or promoted deliberate
20
indifference to the medical needs of inmates. See Gonzalez, 325 F.3d at 1234-
1235; Cottone, 326 F.3d at 1360. Accordingly, absent any showing of a causal
connection between Collins' actions or policies as a PHS supervisor and the
alleged constitutional violations of Bibb County Sheriff's Office employees,
Hilliard and White, the district court properly granted Collins summary judgment,
and we affirm.
We now review Gary's claim against supervisory defendant PHS. Gary
argues that PHS acquiesced to or implemented policies which promoted deliberate
indifference because PHS failed to train Sheriff's Office deputies so that they
could recognize which physical symptoms required immediate medical attention
and properly document medical histories on the PHS screening form. Gary also
alleges that PHS acquiesced to the decision which gave Nurse White responsibility
for screenings after she had been relieved of duties for patient care, and thereby,
cast a blind eye to the use of incompetent medical personnel.
Since PHS provided medical services to inmates at the Bibb County jail
pursuant to a contract with Bibb County, we begin by examining the terms of that
contract to see whether PHS or the County had responsibility for the allegedly
injurious policies. As we noted above, § 1983 eschews any imposition of liability
under a theory of respondeat superior. City of Canton v. Harris, 489 U.S. 378,
21
385, 109 S.Ct. 1197, 1203,103 L.Ed.2d 412, 424 (1989); Hartley, 193 F.3d at
1269; Gonzalez 325 F.3d at 1234. If Gary wishes to hold PHS liable for the policy
that allowed Booking officers to conduct preliminary medical screenings, she
must, as a threshold matter, show that PHS had final authority to establish the
policy or custom in question. See Manor Health Care Corp. v. Lomelo, 929 F. 2d
633, 637 (11th Cir. 1991).
Nothing in the contract between PHS and Bibb County specifically
addresses the practice of having Booking officers fill out Receiving/Screening
forms for inmates. The contract does state, however, that PHS's responsibility for
inmate medical care commences with the booking and physical placement of the
inmate into the LEC, and that PHS would conduct a health evaluation of each
inmate following booking into the facility. The contract delegates the Bibb County
Sheriff as a liaison between the County and PHS and mandates that PHS remove
any personnel about whom the Sheriff voices concerns, unless PHS can resolve
those concerns to the satisfaction of the Sheriff. These terms suggest that the
Sheriff's Office, or Bibb County, but not PHS, exercised final decision-making
authority for the policy that allowed Booking officers to screen inmates' health
risks before they booked the inmates into jail.
Moreover, Gary fails to show any causal connection between this policy and
22
Butts' death, regardless of who the architect of the policy was. The record does not
reference a single prior incident in which a deputy's preliminary screening proved
so ineffective at documenting an inmate's physical condition and / or medical
history that it resulted in a denial of care. If Gary could show that inadequately
trained Booking officers failed to screen inmates who presented serious and
obvious signs of medical distress or risk, she might be able to make a case for her
argument that a policy allowing "inadequate training" caused Butts' injury. See
Harris, 489 U.S. at 387, 109 S.Ct. at 1204, 103 L.Ed.2d at 425-426 (holding that
there are circumstances where inadequate training could cause officers to apply an
otherwise facially valid policy in an unconstitutional manner, allowing plaintiffs to
assert "failure to train" claims as the basis for liability under § 1983).
For liability to attach, however, the identified deficiency would still have to
be closely related to the ultimate injury. Id. at 391. Thus, Gary would have to show
that the deficiency in training actually caused the officer's indifference to Butts'
medical needs. The causal link must consist of something more than just the "mere
probability" that an inadequately trained officer would inflict harm. McDowell,
392 F.3d at 1292, citing Bd. of the County Comm'rs v. Brown, 520 U.S. 397, 412,
117 S.Ct.1382, 1392, 137 L.Ed.2d 626, 644 (1997).
Although, it may have been preferable to have nurses conduct the
23
preliminary medical screening of inmates during booking, there is no evidence to
show that Butts failed to receive an adequate preliminary screening in this case. As
we have noted above, the record shows that Hilliard's preliminary intake on Butts'
alerted Nurse White to the need for follow-up screening. The record does not show
that Hilliard omitted any obvious facts about Butts' medical condition when he
conducted his preliminary screening of Butts.
To analyze Gary's other claim against PHS - that its policy of allowing
Nurse White to return to the Infirmary after she had been removed promoted
deliberate indifference - we look once more to the terms of PHS's contract with
Bibb County. Under the terms of the contract, PHS agreed to provide a physician,
a health care administrator, an R.N. and a secretary, but the Sheriff's Office
stipulated that it would pay for one L.P.N. position up until the time that
individual left the Sheriff's Office employ. Thereafter, PHS would fill the position
for the L.P.N. At the time of Butts' death, Nurse White occupied the Sheriff's
Office's L.P.N. position. Although the Sheriff's Office paid her salary, PHS' health
care administrator , Vickie Irvine, determined what White's duties were within the
Infirmary and supervised her daily activities.
When White returned to the Infirmary several months after she had been
relieved of all duties for patient care, Irvine assigned her to work on screenings.
24
This task required that White interview inmates for additional details on their
medical histories, and collect vital signs such as temperature, pulse rate, blood
pressure, etc. Irvine testified that she had no reason to suspect that White might
fail to complete a screening as she did in Butts' case. Irvine had never received any
complaints about White's ability to conduct follow-up screenings. Thus, Gary
cannot show that PHS was ever put on notice that White might deprive an inmate
of adequate care by failing to perform a screening or that PHS implemented any
particular policy that would have sanctioned White's alleged misconduct in this
case.
Since Gary has failed to establish any causality between Butts' death and a
PHS policy, whether it involved acquiescence to the practice of having Sheriff's
deputies conduct preliminary screenings of inmates during booking or the decision
to reassign Nurse White to screenings, a task which she appears to have performed
without incident prior to this point, we find that the district court properly granted
PHS summary judgment.
We complete our analysis of the supervisory defendants by examining
Gary's claims against Bibb County. Here, once again, Gary argues that the
defendant implemented policies which promoted deliberate indifference to the
medical needs of inmates. She finds evidence of such a policy in the County's
25
decision to countenance the Sheriff's practice of using deputies on preliminary
medical screenings. Bibb County argues that it bears no supervisory responsibility
for the actions of the Sheriff's Office or Sheriff's Office employees, citing
provisions of the Georgia Constitution which make the Sheriff's Office subject to
the legislative control of the state and emphasize the Office's independence from
counties and their governing bodies.
While the Georgia Constitution does indicate that a Sheriff occupies a
separate constitutional office in the state's governmental hierarchy, Ga. CONST.
art. IX, § 2, and that the Georgia legislature alone controls the Sheriff's Office, Ga.
CONST. art IX, § 1, ¶ 3(a)(b), Georgia statute requires that governmental units
provide medical care to all inmates in their physical custody. O.C.G.A. §42-5-2
(2006); Manders v. Lee, 338 F.3d 1304, 1323 n.43 (11th Cir. 2003). Georgia
statute imposes the same affirmative duty upon sheriffs, requiring that the sheriff
take custody of all inmates in the jail of his county, O.C.G.A. §42-4-4(a)(1)
(2006), and furnish them with medical aid, heat and blankets, to be reimbursed if
necessary from the county treasury. O.C.G.A. §42-4-4 (a)(2) (2006).
Given that county governments have a statutory obligation to provide
inmates in county jails with access to medical care, Bibb County cannot avoid
liability under § 1983 simply by arguing that the Sheriff is subject to the exclusive
26
control of the state. See Manders, 338 F.3d 1323 n.43. If Gary could show that
Bibb County implemented a policy which promoted deliberate indifference to the
medical care of inmates, and that the policy caused Butts death, she could hold the
County liable, and we stress the word "if." Gary has failed to articulate a County
policy that promoted deliberate indifference, and as we have noted previously, she
has not provided any evidence from which we could infer that Deputy Hilliard
failed to note an obviously serious medical condition on Butts' screening form and
that this omission led to Butts' death. Accordingly, we affirm the district court's
decision to award Bibb County summary judgment.
C. Liability of Custodial Defendants
In addition to suing various supervisory officials, Gary also named the
correctional officers who booked Butts into detention and guarded his cell block
and the Infirmary nurses who reviewed his medical records as defendants in her §
1983 action. She alleged that these custodial defendants violated Butts'
constitutional rights by withholding essential medical care when he was in serious
need. This group includes Bibb County Sheriff's Office Deputy Ray Hilliard, who
booked Butts and conducted a preliminary medical screening of him, Bibb County
Sheriff's Office deputies Jack Cleveland, Harry Lawrence, Jerry Minton, Antonio
Driskell, who stood watch over Butts' cell block, and Infirmary nurses Sandra
27
White and Rosemarie Davis, who received Butts' medical screening form and / or
sick call request.
As we have noted previously, to establish that these prison officers and
medical providers violated Butts' Fourteenth Amendment rights, Gary must point
to facts in the record that show or allow us to infer: 1) the officials were aware a
substantial risk of serious harm existed, and 2) they failed to respond to the risk in
a reasonable manner. Farmer, 511 U.S. at 847, 114 S.Ct. at 1984, 128 L.Ed.2d at
832; Marsh, 268 F.3d at 1028; Farrow, 320 F.3d at 1243. To establish liability for
the violations under § 1983 Gary must also show that the alleged acts of deliberate
indifference caused Butts' death. Marsh, 268 F.3d at 1028.
We have discussed defendant Ray Hilliard's actions at length in preceding
parts of this opinion and need not elaborate upon that discussion to affirm the
district court order granting Hilliard summary judgment. As we have noted,
nothing in the record shows that Hilliard failed to screen Butts for outwardly
obvious signs of medical distress, failed to record Butts' medical history exactly as
Butts relayed it to him, or failed to submit Butts' medical screening form in a
timely manner to PHS. Moreover, nothing in the record indicates that Hilliard's
actions caused Butts' death. To the contrary, the record demonstrates that Hilliard's
notes succeeded in alerting medical personnel to Butts' health risks because Nurse
28
White testified she immediately prioritized Butts for follow-up after she read
Hilliard's preliminary intake on Butts.
We cannot say the same thing with respect to the remaining custodial
defendants, however. Disputes over issues of material fact apply in the case of
each of these defendants. The substantive law on deliberate indifference claims
tells us that the question of whether a prison official had subjective knowledge of
a substantial risk to an inmate's health will be material to determining liability
under § 1983. See Farmer, 511 U.S. at 847,114 S.Ct. at 1984, 128 L.Ed.2d at 832.
Although each of the remaining defendants asserts that they did not know Butts
was in serious need of medical attention, other witnesses challenge their testimony
on this point. In such situations, the fact-finder must assess the credibility of
competing witnesses to reconcile the record. A judge may not make credibility
determinations, however. That task falls to a jury. Reeves v. Sanderson Plumbing
Prods., Inc., 530 U.S. 133, 150-151, 120 S.Ct. 2097, 2110, 147 L.Ed.2d 105, 122
(2000), citing Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 255, 106 S.Ct. 2505,
2513, 91 L.Ed.2d 202, 216 (1986).
We begin by examining the evidence against the correctional officers who
guarded Butts' cell block on the 16th and 17th of October and focus our initial
discussion on deputies Harry Lawrence and Jack Cleveland because both these
29
deputies reported finding Butts on the floor outside his cell on the morning of his
death. Lawrence testified that he saw Butts lying on the floor of F-wing, the
minimum security cell block where Butts was housed, when Lawrence entered the
wing to begin his day shift between 6:45 - 7:00 a.m. on the 17th of October.
Lawrence drew a sketch to show where Butts lay in relation to the guard's control
booth. The sketch placed Butts directly in Lawrence's path. Lawrence admitted
that he went past Butts without stopping to check on him, but insisted that he saw
nothing unusual about finding an inmate asleep on the floor, and that by the time
he came out of the control booth to begin the block check another inmate was
helping Butts to his bunk.
Testimony by Lawrence's co-workers contradicts this assertion, however.
Other correctional officers, including Minton and Driskell, the officers who were
on duty when Lawrence arrived, testified that they would consider it unusual to
find an inmate asleep on the floor at the beginning of a shift and that protocol
would require that they check the inmate out for signs of bleeding or distress. LEC
protocol on block checks dictated that inmates had to be in their cells for block
checks, and the record shows that Minton and Driskell completed their last regular
block check at 6:00 a.m., less than an hour before Lawrence arrived. Yet,
Lawrence testified that he did not ask deputies Minton and Driskell, who were
30
stationed inside the control booth, what Butts was doing there because he just
didn't consider it significant.
Lawrence's subsequent actions belie this assertion, however. Clearly,
Lawrence had second thoughts about whether Butts' condition beared noting for
after he completed the change of shift block check at 7:15 a.m. and wrote "10-4"
in the logbook to indicate there were "no problems," he added several sentences
about Butts in the margins of the logbook. Lawrence's margin notes contrast
pointedly with the other logbook entries. Other logbook entries use words
sparingly, and substitute code such as "10-4" for phrases. Here, though, Lawrence
wrote out five full sentences, noting that: "F120 Butts Jerry was laying in the floor
[a]sleep. He was taken into his cell by another inmate. Butts, Jerry was OK at this
time. He was awake. He didn't say anything was wrong with him."
Lawrence insisted that he made these notes about an hour after he
completed the 7:00 a.m. block check, but they read like a postscript added after the
day's events unfolded. The record shows that Lawrence never checked on Butts
again until Butts' cellmate summoned Lawrence at 2:45 p.m. to report that Butts
had collapsed. These facts could lead a reasonable fact-finder to infer that
Lawrence edited his logbook entry on the 7:15 a.m. block check in order to create
a more favorable record of his conduct after Butts died, realizing, in hindsight, that
31
his actions could appear deliberately indifferent or negligent. Since Rule 56(c)
mandates that we draw all reasonable inferences such as these in the light most
favorable to the non-moving party, FED. R. CIV. P. 56(c), we can infer that
Lawrence had subjective knowledge of the serious health risk facing Butts that
morning of the 17th, and he chose to ignore it.
Deputy Cleveland followed Lawrence in several minutes later and also
noticed Butts lying on the floor in between the control booth and his cell.
Cleveland, unlike Lawrence, stopped and tried to speak with Butts. Cleveland
testified that he thought Butts was drunk because his speech was
incomprehensible. Yet, Cleveland admitted that he didn't detect any alcohol on
Butts' breath when he leaned over to rouse him. Other deputies and nurses
testified, however, that, as a matter of booking protocol, a drunken inmate would
not have been placed in the general population until he had sobered up first in a
holding tank, and that it would be highly unusual to suspect that an inmate would
be lying on the floor of his cell block drunk.
Cleveland testified that an inmate approached to help Butts into his bunk
and he followed them, trying once more to speak with Butts. His second attempt to
get an answer out of Butts failed much like his first, Cleveland recalled. He
insisted that he went into the control booth at this point and called the Infirmary,
32
alerting them to what had just transpired with Butts and letting them know that he
would drop Butts off once he reawakened. Cleveland testified that he believed he
spoke with Nurse Davis, however, Nurse Davis denied ever receiving such a
phone call. Cleveland decided to check on Butts once more around 10:00 a.m. or
11:00 a.m. He found Butts still unresponsive. Then Cleveland signed himself off-
duty at 1:00 p.m., without attempting to check on Butts again, and without
updating the Infirmary or discussing Butts condition with his co-worker, Deputy
Lawrence.
By his own admission, Cleveland recognized that Butts should be seen in
the Infirmary, yet his subsequent actions evidence a disregard for Butts' medical
needs. He never escorted Butts to the Infirmary, as he claims to have told the
Infirmary that he would, and he never told Deputy Cleveland, his day-shift partner,
that Butts needed to be taken up to the Infirmary when he signed himself off-duty
at 1:00 p.m. These facts betray deliberate indifference to Butts' medical needs.
We may now examine the conduct of deputies Jerry Minton and Antonio
Driskell, who were on duty in Butts' cell block when Lawrence and Cleveland
arrived on the morning of the 17th. Both deputies testified that LEC protocol
dictated they remain on duty in the control booth until their replacements
completed a block check. In their affidavits Minton and Driskell stated that no
33
inmates were lying on the floor of the dayroom when the day shift relieved the
night shift on the morning of October 17th. They also acknowledged in incident
reports that they filed after Butts' death that Butts would have been in "plain sight"
of the control booth if he had been lying where deputy Lawrence's testimony
placed him. Minton and Driskell did their last block check at 6:00 a.m., less than
an hour before Lawrence arrived to take over the shift and they noted that the
block check proceeded "10-4", meaning without incident. Several deputies
testified that protocol required inmates remain in their cells during block checks.
Butts' cellmate, David Lucas, testified that Butts left their cell sometime
between 5:30 a.m. and 7:00 a.m. to go to the bathroom. Butts never made it back
to the cell on his own, Lucas testified, because he awoke at 7:00 a.m. to the sound
of a deputy yelling at someone, and stepped outside his cell to find a deputy
leaning over Butts, who was lying on the bare floor of the cell block between cell
F120 and the control booth. Lucas testified that he ran out at this point to help
Butts back to their cell.
We find it difficult to reconcile the testimony that the deputies for the
incoming shift and Butts' cellmate provide on this point with the testimony and
other statements that the deputies on the outgoing shift provide. Either it was
apparent from the vantage of the control booth that an inmate was lying on the
34
floor sometime between 6:00 a.m. and 6:45 a.m., a fact that should have the
elicited a response from the guards on duty, or the inmate wasn't where several
witnesses say he was. One very reasonable inference that we may draw from these
facts is that Butts collapsed when he left the cell to use the bathroom sometime
after 6:00 a.m. on the 17th, and that Minton and Driskell either saw him collapse
and ignored him, or had their eyes directed elsewhere. In either case, they would
have been ignoring their duties to monitor the inmates.
Minton and Driskell insist that they never noted any signs of distress in
Butts over the course of their night shift on the 16th of October and that no one
brought any problems to their attention. The record bears this out to a point.
Minton and Driskell visited Butts cell at least four times during their shift on the
16th and 17th of October, at 7:00 pm.,12:00 a.m, 2:00 a.m. and finally, 6:00 a.m.
On each of these occasions they entered the notation "10-4" beside their logbook
entry for the block checks to indicate that they noted no problems. Yet, the only
way they could have failed to note that Butts was experiencing a problem around
6:45 a.m. on the 17th is if they had their eyes directed elsewhere. Thus, a dispute
exists as to a very material fact - whether Minton and Driskell had subjective
knowledge that Butts faced a substantial risk of serious harm if left unattended on
the morning of the 17th.
35
Although the record indicates that disputes exist as to the question of
whether Butts' guards knew he was at substantial risk of serious harm, and ignored
the risk, we note that this is only one element of a § 1983 deliberate indifference
claim. Gary still needs to establish a causal link between the guards' actions and
Butts' death. The record provides evidence to suggest that Butts was experiencing
cardiac distress on the morning of the 17th when he was found on the floor of his
cell block. The defendants suggest that he was "asleep." The testimony of his
cellmate suggests that he probably collapsed. At the very least, the record shows
that Butts could not make it back to his bunk on his own and this fact suggests
some level of distress. Thus, we also find evidence of a dispute on this very
material fact.
Accordingly, the district court's decision to grant defendants Lawrence,
Cleveland, Minton and Driskell summary judgment in this action did not conform
to the requirements of Rule 56(c), which provide that summary judgment is
improper where a genuine dispute exists with regard to an issue of material fact,
and we reverse the court's order. FED. R. CIV. P. 56(c).
We now review the record on the remaining custodial defendants, Infirmary
nurses White and Davis. Nurse White testified that she prioritized him for follow-
up screening immediately after she read his screening form and noted that he had
36
been treated in the past for both a heart condition and high blood pressure and was
on medication. She also testified that she told her co-worker, Nurse Davis, that
Butts needed to be screened before the next shift came on duty on the 16th
because of his medical history. These facts suggest that White had subjective
knowledge of the substantial health risks facing Butts should he fail to receive
follow-up medical screening.
White testified that she proceeded to look for Butts with dispatch and found
him at a shower holding cell in Booking. She told him that she needed to speak to
him and that she would get back to him after she completed another screening.
Although White testified that she did not detect any signs of immediate distress
when she first spoke to Butts, the record indicates that she had only a passing view
of Butts at best, as he was waiting to dress out of his clothes and into his prison
uniform at the time, and their exchange was limited. Thus, her initial decision to
conduct a follow-up of Butts with dispatch and her testimony of what she told
Nurse Davis suggest she did have some sense of the potential severity of Butts'
condition.
If so, the record suggests that she also disregarded that risk because she left
work that day without completing Butts' medical screening. Her supervisor
testified that such a failure would subject White to an automatic disciplinary
37
action, but admitted that nurses sometimes were unable to complete screenings
before the end of their shifts and that the responsibility to complete the screening
would fall to those who remained on duty or to those who assumed duty on a
subsequent shift.
White insisted that she told her co-worker, Nurse Davis, that she had been
unable to complete the screening and explained that his screening should be
prioritized for completion before the next shift because of his medical history.
According to White, Davis acknowledged her concerns and told her to leave Butts'
screening form on her desk. Davis testified, however, that this conversation never
took place. Thus, the record clearly reveals a genuine dispute on this issue of
material fact.
If Davis's testimony is truthful, then White ignored Butts' needs for medical
attention, although she had subjective knowledge that he faced a substantial risk of
serious harm. This would constitute deliberate indifference. We cannot resolve the
conflict between White's testimony and Davis' testimony solely by looking at the
record. Nor could the district court. Since Rule 56(c) precludes summary judgment
in such cases, See Liberty Lobby, Inc., 477 U.S. at 255, 106 S.Ct. at 2513 91
L.Ed.2d at 216, we reverse the order granting summary judgment to Nurse White.
We complete our review of the custodial defendants by looking at the
38
testimony of Nurse Davis. Davis testified that she had no contact with Butts and
no knowledge of his medical history until she reviewed his screening form after
the "terminal event." Yet, as we have noted, Deputy Cleveland's testimony and
Nurse White's testimony openly contradict Davis on this point. Deputy Cleveland
said that he called Davis at 7:15 a.m. to report that Butts had been found lying on
the floor of the cell block and would be sent up to the Infirmary once he
awakened. Davis' supervisor, Vickie Irvine, testified that she probably would have
gone directly to Butts' wing at that point. Nurse White testified that she told Davis
Butts needed to be screened as soon as possible on the afternoon of the 16th
because of his medical history. Davis admitted that Infirmary protocol dictated on-
duty nurses would be responsible for completing any unfinished screenings,
regardless of whether the screening had been assigned to someone else initially.
The only way to reconcile this sort of conflicting testimony is to assess the
credibility of the witnesses, and Rule 56(c) precludes summary judgment in such
cases. See Liberty Lobby, Inc., 477 U.S. at 255, 106 S.Ct. at 2513 91 L.Ed.2d at
216.
Moreover, in a statement that she provided to internal affairs after Butts'
death, Davis acknowledged receiving Butts' sick call request on the 17th at 2:00
p.m. Butts had submitted the request the evening prior at 6:10 p.m. and Infirmary
39
protocol dictated that sick call requests would be retrieved from the control booths
whenever nurses came around to dispense medications. The logbook indicates that
nurses visited Butts' cell block to dispense medicine at 7:15 p.m. on the 16th and
again at 4:30 a.m. the following day. The record does not indicate why nurses did
not log Butts' sick call request until 2:00 p.m. on the 17th, however.
When Davis finally received Butts' sick call request she took no action on it,
noting quixotically that outside medications had not been assigned. The record
does not provide any explanation for why she would fail to respond to a sick call
request and investigate Butts' complaint, whether medication had been assigned or
not. If we view these facts in the light most favorable to the non-moving party, we
may infer quite reasonably that Nurse Davis knew Butts had clear health risks and
chose to ignore the risks by withholding medical care. Accordingly, we reverse the
district court order granting summary judgment to defendant Davis.
IV. CONCLUSION
We AFFIRM the district court order granting summary judgment to the
defendants in part and REVERSE in part. Specifically, we AFFIRM that portion
of the order granting summary judgment to defendants Modena, Collins, PHS,
Bibb County and Hilliard, as well as the defendants who Gary agreed to dismiss,
Nelson, Gunnels, Boatwright, Joiner, and Mosely, and we REVERSE that portion
40
granting summary judgment to defendants Cleveland, Lawrence, Minton, Driskell,
White and Davis and REMAND for trial as to those defendants.
41
PRYOR, Circuit Judge, concurring in part and dissenting in part:
This appeal presents a classic example of bad facts making bad law. Jerry
Butts died while incarcerated at the Bibb County Law Enforcement Center (LEC),
in Bibb County, Georgia. Butts’s daughter, Valencia Gary, then sued officers,
nurses, supervisory officials, and governmental entities on the ground that they
were deliberately indifferent to Butts’s serious medical needs, but the evidence
does not support Gary’s allegations. There is no evidence that any defendant had
a subjective knowledge of a risk of serious harm to Butts; at worst, the evidence
supports the inference that the defendants were negligent. That inference is not
enough. The Constitution requires evidence of deliberate indifference to a
substantial risk of serious harm. Farmer v. Brennan, 511 U.S. 825, 832-40, 114 S.
Ct. 1970, 1976-80 (1994). Because the precedents of the Supreme Court and our
Court do not allow us to punish negligence toward pretrial detainees nor require
jail officials to be clairvoyant, I respectfully dissent from the disposition by the
majority opinion of Gary’s claim against defendants Cleveland, Lawrence,
Driskell, Minton, White, and Davis. I concur in the resolution by the majority
opinion of the claims against the remaining defendants.
42
I. BACKGROUND
Because the resolution of this appeal turns heavily on the facts, I briefly
review those facts, keeping in mind that we must view them in the light most
favorable to the plaintiff.
The evidence establishes that Jerry Butts was brought to the Bibb County
LEC on October 16, 2001, at approximately 10 a.m. Deputy Ray Hilliard filled
out a preliminary medical questionnaire with Butts. The questionnaire noted that
Butts had been treated for a heart condition and high blood pressure and suffered
from chest pains. The questionnaire also noted that Butts was on medication but
did not specify what medication or the purpose of the medication. Nurse Sandra
White received Butts’s screening form sometime that afternoon and determined
that Butts should be screened based on his past treatment. White searched for
Butts and found him at a shower holding cell. White spoke to Butts but did not
detect any signs of distress. White was unable to screen Butts then, but she
informed him that she would see him later. Although she later attempted to find
Butts and complete a screening, White ultimately failed to screen Butts and left at
the end of her shift, which was at 4 p.m. Although White testified that she gave
the other nurse on duty, Nurse Rosemarie Davis, Butts’s questionnaire and
informed Davis that Butts needed to be screened, Davis denied that White said
43
anything about Butts.
Butts was assigned to F-wing, the minimum security section of the LEC and
was placed in a cell with David Lucas. At approximately 6:10 p.m., Lucas
completed a sick call request form for Butts, which Butts signed and in which he
complained of severely swollen ankles and feet. At 7 p.m., deputies Jerry Minton
and Antonio Driskell assumed the watch over Butts’s cell block. Minton and
Driskell checked the cell block four times at 7 p.m., 12 a.m., 2 a.m., and 6 a.m. On
each occasion they did not note anything unusual. Butts’s cell-mate, David Lucas,
testified that Butts complained all night that he was sick and needed medication
and that Butts went back and forth to the control booth and complained to the
officers that he needed medication. Lucas also stated that Butts asked a nurse at 7
p.m. for medication but the nurse said she would attend to Butts later.
At approximately 6:45 a.m. on October 17, 2001, deputies Jack Cleveland
and Harry Lawrence separately entered the cell block. When Lawrence entered
the block, Butts was lying on the floor in his path. Lawrence did not stop to check
on Butts. When Lawrence came back out of the control booth for the 7 a.m. block
check, Lucas was helping Butts back to his bunk. Butts was walking and Lucas
had his arm around Butts’s shoulder. Butts appeared to Lawrence to be waking
from sleep. Cleveland entered the cell block and also observed Butts on the floor.
44
Cleveland attempted to speak with Butts, whom he thought was drunk. When
Lucas came to help Butts to his bunk, Cleveland asked Lucas if Butts was drunk,
and Lucas responded that Butts was sick. Cleveland then called the Infirmary and
reported to Davis that he had found an inmate sleeping on the floor and would
bring him to the Infirmary when he awoke. Cleveland checked on Butts later in
the morning. He did not rouse Butts because it appeared to Cleveland that Butts
was sleeping.
At approximately 2 p.m., Davis received Butts’s sick call request from the
previous night but did not take immediate action on the request. At approximately
3 p.m., Butts collapsed in his cell. Lucas and another inmate called the officers on
duty, who contacted the Infirmary. White and Davis responded to the call. Butts
was rushed to the emergency room where he was pronounced dead from acute
heart failure.
II. DISCUSSION
The test to establish deliberate indifference to a serious medical need
involves both an objective and a subjective element. Kelley v. Hicks, 400 F.3d
1282, 1284 (11th Cir. 2005). Objectively, a “serious medical need is considered
one that has been diagnosed by a physician as mandating treatment or one that is
45
so obvious that even a lay person would easily recognize the necessity for a
doctor's attention.” Farrow v. West, 320 F.3d 1235, 1243 (11th Cir.2003) (internal
quotation marks and citation omitted). The subjective element, is established with
evidence that “the defendant had (1) subjective knowledge of a risk of serious
harm; [and] (2) disregard[ed] ... that risk; (3) by conduct that is more than mere
negligence.” Cook ex rel. Estate of Tessier v. Sheriff of Monroe County, Fla., 402
F.3d 1092, 1115 (11th Cir. 2005). In other words, an official cannot be liable
unless “the official knows of and disregards an excessive risk to inmate health or
safety; the official must both be aware of facts from which the inference could be
drawn that a substantial risk of serious harm exists, and he must also draw the
inference.” Farmer v. Brennan, 511 U.S. 825, 837, 114 S. Ct. 1970, 1979 (1994).
“[A]n official’s failure to alleviate a significant risk that he should have perceived
but did not, while no cause for commendation, cannot under our cases be
condemned as the infliction of punishment.” Id.
The majority concludes that the evidence presented by Gary is sufficient to
preclude summary judgment on the basis of qualified immunity in favor of
Officers Cleveland, Lawrence, Driskell, and Minton and Nurses White and Davis.
To reach that conclusion, the majority repeatedly draws impermissible inferences
and misapplies our precedent. The district court correctly concluded that there is
46
no evidence that any defendant knew of Butts’s serious condition or of a risk of
serious harm.
Gary’s complaint includes claims against two members of the medical staff
on duty when Butts was incarcerated and claims against the four officers who were
on either the night shift before or the day shift on the day that Butts died. I first
address the plaintiff’s claims against the medical staff, Nurses White and Davis,
who had seen Butts’s intake questionnaire and were at least on notice of his
medical history. Second, I address the plaintiff’s claims against Officers Minton,
Driskell, Lawrence and Cleveland, in that order.
Of the two nurses, Nurse White was the first to have contact with Butts.
The majority concludes that, because White considered Butts a priority and told
Davis that Butts was a priority for screening that White “had subjective knowledge
of the substantial health risks facing Butts should he fail to receive follow-up
medical screening,” and “she did have some sense of the potential severity of
Butts’ condition.” Op. at 37. The problem with the conclusion of the majority is
that none of this evidence establishes more than negligence.
Butts’s screening form asked, “Have you had or been treated for” a heart
condition and high blood pressure. The screening form did not state any current
47
symptoms of distress, and White did not observe any signs of distress when she
spoke with Butts. The screening form stated that Butts had taken or was taking
medications prescribed by a physician, but the form did not state what the
medications were or for what condition they were prescribed. White determined
that Butts should be given priority for screening, but this evidence does not
establish that she had a subjective knowledge that Butts was at risk of serious
harm if he did not receive medical attention soon or within 24 hours.
White’s failure to screen Butts does not give rise to an inference of
deliberate indifference because there is no evidence that White had a subjective
knowledge of a risk of serious harm to Butts. What the majority describes as
“some sense of the potential severity” is not enough. Op. at 37(emphasis added).
At worst, White’s failure to complete the screening was negligent. The evidence
that White informed Davis of Butts’s situation, far from supporting a claim of
deliberate indifference, suggests that White both personally observed Butts and
took steps to ensure that Butts was screened.
Even if we were to assume that White did not inform Davis about Butts, that
failure does not constitute deliberate indifference because there is no evidence that
White had a subjective knowledge of a substantial risk of serious harm to Butts. If
White did not inform Davis, the only evidence of White’s knowledge consists in
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her statement that she considered Butts a priority for screening. White’s belief
that Butts should be screened soon because of his history is not the same as a
belief that he was at substantial risk of serious harm. In fact, White did not know
anything that would have led her to conclude that Butts was at risk of serious
harm. If White failed to communicate Butts’s condition to Davis, then that failure
was negligent at worst.
The evidence against the other nurse, Davis, is even less substantial than the
evidence against White. According to White, Davis was told that Butts should be
screened because of his history, but there is no evidence that Davis was given
information that Butts was at substantial risk of serious harm. Davis also received
a call from Cleveland that an inmate was found on the floor and would be brought
to the Infirmary when he awoke, but that call would not alert Davis to a risk of
serious harm or that she should take immediate action. There also is no evidence
that Cleveland told Davis the name of the inmate, and Cleveland told Davis that he
thought the unnamed inmate was drunk. Finally, Butts’s sick call request, which
Davis received at approximately 2 p.m. the following day, complained of swollen
ankles and feet. Even with Butts’s history, there is no evidence that these
symptoms put Davis on notice of a substantial risk of serious harm, and Davis’s
delay of one hour in seeing Butts, after she received the sick call request, does not
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give rise to an inference of deliberate indifference to a known serious risk.
The evidence against deputies Minton and Driskell also does not establish
that the deputies had a subjective knowledge of a risk of serious harm. The
evidence with respect to each deputy establishes that they conducted four block
checks and found no problems on each check. According to Lucas, Butts told the
deputies that he needed medication, but there is no evidence that Butts was in
visible distress or that Minton and Driskell knew that Butts was on medication for
heart problems and high blood pressure. At some point between 6 and 6:45 a.m.,
Butts fell or laid down on the floor outside the control booth, but neither deputy
saw him.
The majority concludes, “One very reasonable inference that we may draw
from these facts is that Butts collapsed when he left the cell to use the bathroom
sometime at 6:00 a.m. on the 17th, and that Minton and Driskell either saw him
collapse and ignored him, or had their eyes directed elsewhere. In either case, they
would have been ignoring their duties to monitor the inmates.” Op. at 35. The
majority then concludes that “a dispute exists as to a very material fact - whether
Minton and Driskell had subjective knowledge that Butts faced a substantial risk
of serious harm if left unattended on the morning of the 17th.” Id.
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There are at least three problems with this inference. First, noone knows
when Butts collapsed on the floor outside the control booth. When Butts was
found at 6:45 a.m. he could have been on the floor anywhere from 1 to 45 minutes;
the duration of this period depends on speculation, not evidence. Second, both
Minton and Driskell testified that they did not see Butts on the floor, and neither
Cleveland nor Lawrence, the officers who saw Butts, asked Minton or Driskell
why he was there. Third, because Minton and Driskell do not have eyes on all
sides of their heads, it is entirely possible that they had their eyes diverted when
Butts fell and did not see him as they testified. There is no evidence to the
contrary. At worst, the evidence allows an inference that Minton and Driskell
were, as the majority states “ignoring their duties,” which is another way of saying
negligent in their responsibility of watching the inmates. Negligence is not
sufficient to establish deliberate indifference. See Cook, 402 F.3d at 1115.
Lawrence was on duty when Butts was brought to F-wing on October 16
and was on duty until 7 p.m. that night. There is no evidence that Lawrence was
aware of any problems with Butts before he went off duty. Although Butts
requested and received a sick call request form sometime in the afternoon on
October 16, there is no evidence that Lawrence was aware of the request or saw
Butts’s sick call form.
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On the following day, Lawrence entered the cell-block at approximately
6:45 a.m. to start his shift. Lawrence had to walk past Butts, who was lying on the
floor, but did not stop to check on him. Lawrence testified that he thought Butts
was sleeping and that he did not think it unusual to find an inmate asleep on the
floor. When Lawrence came back out of the control booth, not 15 minutes later,
Butts was being helped to his bunk by Lucas. Butts was walking and Lucas had
his arm around Butts’s shoulder. Later, Lawrence asked Lucas if Butts was all
right. Lucas responded that Butts was okay but was sick. Lucas also told
Lawrence that he had filled out a sick call request for Butts. At approximately
8:30 a.m., after completing his block checks, Lawrence wrote in the logbook that
Butts “was laying on the floor [a]sleep. He was taken into his cell by another
inmate. Butts, Jerry was OK at this time. He was awake. He didn’t say anything
was wrong with him.” After lunch, when Butts collapsed in his cell, Lucas
contacted Lawrence in the control booth and told him that there was a man down.
Lawrence responded and called the Infirmary nurses to come to Butts’s aid.
The majority concludes that Lawrence’s testimony, that he thought Butts
was sleeping and did not find his presence on the floor unusual, is suspect for
several reasons. First, other officers testified that they would consider it unusual
to find an inmate asleep on the floor and protocol would require they check the
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inmate for bleeding or distress. Second, Lawrence’s notes in the logbook suggest
that Lawrence considered seeing Butts’s on the floor to be somewhat unusual or
he would not have made a note in the logbook. Third, the majority infers from the
style of Lawrence’s note that Lawrence edited the logbook after Butts’s death to
create a more favorable impression. From these facts, the majority infers that
Lawrence had subjective knowledge of a serious risk of harm to Butts and ignored
that risk.
The evidence described by the majority and the reasonable inferences from
that evidence do not add up to deliberate indifference. First, no evidence leads to
a reasonable inference that Lawrence had a subjective knowledge of a risk of
serious harm to Butts on October 17. There is no evidence that Lawrence had any
subjective knowledge of Butts’s condition that would make him more sensitive to
unusual behavior. Lawrence had not seen Butts’s intake questionnaire, his sick
call request, or received other information that would alert him that Butts was ill.
Second, that other officers would have considered it strange to see an inmate
sleeping on the floor does not create a reasonable inference that Lawrence
subjectively knew Butts was at substantial risk of serious harm. The evidence
instead establishes that Lawrence objectively should have followed protocol and
checked Butts’s condition, as the other officers would have done, to determine if
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Butts was in distress. That Lawrence failed to follow jail protocol establishes, at
worst, that Lawrence was negligent in his care of Butts. Third, that Lawrence later
asked about Butts does not give rise to a reasonable inference that Lawrence knew
of a substantial risk of serious harm to Butts. Fourth, the inference by the majority
that Lawrence edited his logbook after the events of the day, because he realized
in hindsight that Butts had been sick, also does not give rise to a reasonable
inference that Lawrence had subjective knowledge of a risk of serious harm to
Butts before that harm unfolded.
Cleveland also entered the cell-block at approximately 6:45 a.m. to start his
shift. Cleveland stopped to talk with Butts, and thought Butts was drunk because
his speech was slurred. According to Lucas, Cleveland “use[d] some vulgarity
and t[old] [Butts] to get his so and so up off that floor you old drunken so and so.”
Lucas came out his cell to help Butts to his bunk and told Cleveland that Butts was
not drunk but sick. Cleveland then called the Infirmary and told Davis that he had
found an inmate asleep on the floor, who appeared to be drunk, and that he would
bring him over when the inmate awoke. Cleveland checked on Butts between 10
and 11 a.m. and attempted to speak with him, but Butts did not respond and
appeared to be sleeping. Cleveland went off duty at 1 p.m. without updating the
Infirmary or discussing Butts with his coworker.
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The majority concludes, based on Cleveland’s testimony that he called the
Infirmary about Butts, that “Cleveland recognized that Butts should be seen in the
Infirmary, yet his subsequent actions evidence a disregard for Butts’ medical
needs. He never escorted Butts to the Infirmary, as he claims to have told the
Infirmary he would, and he never told Deputy [Lawrence], his day-shift partner,
that Butts needed to be taken up to the Infirmary when he signed himself off-duty
at 1.00 p.m.” Op. at 33. The majority concludes that this evidence is sufficient to
establish deliberate indifference.
What the majority ignores is that none of the evidence presented establishes
that Cleveland had a subjective knowledge of a “risk of serious harm” to Butts.
The evidence establishes that Cleveland thought Butts was drunk and sleeping.
Although Cleveland thought it would be beneficial for an Infirmary nurse to
examine Butts, that evidence is not akin to subjective knowledge that Butts was at
risk of serious harm if an Infirmary nurse did not examine him. There is no
evidence that Cleveland knew Butts’s medical history or had any information that
would lead him to conclude that Butts was at risk of serious harm. At worst, it
was negligent of Cleveland to leave work without taking Butts to the Infirmary or
instructing his shift-partner to take Butts to the Infirmary.
Although it is tragic that Jerry Butts died while in the custody of the Bibb
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County LEC, we are not allowed by the Constitution to place responsibility for
that death at the feet of the individual officers and staff responsible for supervising
Butts when there is no evidence that any of those individuals had subjective
knowledge of a risk of serious harm to Butts and deliberately ignored that risk.
The Constitution requires that a prison official must have a “sufficiently culpable
state of mind,” Wilson v. Seiter, 501 U.S. 294, 297, 111 S. Ct. 2321, 2323 (1991),
before that official will be subject to suit because “‘only the unnecessary and
wanton infliction of pain implicates the [Fourteenth] Amendment,’” Farmer, 511
U.S. at 834, 114 S. Ct. at 1977 (quoting Wilson, 501 U.S. at 297, 111 S. Ct. at
2323). Because the plaintiff did not meet her burden to establish this state of
mind as to any defendant, I would affirm the judgment of the district court in its
entirety.
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