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Kindoll v. Southern Health Partners

United States District Court, E.D. Kentucky, Northern Division, Covington

March 28, 2019

MICHELLE KINDOLL PLAINTIFF
v.
SOUTHERN HEALTH PARTNERS, et al. DEFENDANTS

          MEMORANDUM OPINION AND ORDER

          DAVID L. BUNNING UNITED STATES DISTRICT JUDGE.

         On May 5, 2016, Plaintiff Michelle Kindoll was arrested for possession of heroin and transported to the Grant County Detention Center (“GCDC”). During her time at the GCDC, Plaintiff suffered a stroke, which she alleges resulted in permanent speech and mobility impairments.

         On May 12, 2017, Plaintiff filed suit against two groups of Defendants: (1) the “County Defendants, ” comprised of Grant County, and (in both their individual and official capacities) Corporal Audra Napier, Deputy Tammy Bullock, Jailer Christopher Hankins, and John and Jane Doe; and (2) the “SHP Defendants, ” comprised of former GCDC medical services contractor Southern Health Partners, Inc. (SHP), and its employees, nurses David Watkins, RN, Debbie Preston, LPN, and David Ross, LPN.[1] (Doc. # 1). Plaintiff's Complaint sets forth four counts-one constitutional claim and three state-law claims. Count One asserts a claim against all Defendants pursuant to 42 U.S.C. § 1983. Count Two asserts a medical malpractice action against Defendants Preston, Ross, and Watkins under Kentucky law. Count Three asserts a negligence claim against SHP under Kentucky law. Finally, Count Four asserts a negligence claim against Defendants Napier, Bullock, and John and Jane Doe under Kentucky law.

         There are currently two Motions for Summary Judgment before the Court (Docs. # 62 and 83), wherein both groups of Defendants seek summary judgment on all claims. The SHP Defendants have also filed a Motion to Strike (Doc. # 79), which the Court will take up along with these dispositive motions. All three motions are fully briefed and ripe for review. (Docs. # 73, 77, 78, 79, 80, 86, 92, 98 and 99). For the reasons set forth below, the County Defendants' Motion for Summary Judgment (Doc. # 62) is denied in part and granted in part; the SHP Defendants' Motion to Strike (Doc. # 79) is denied; and the SHP Defendants' Motion for Summary Judgment (Doc. # 83) is denied in part and granted in part.

         I. FACTUAL AND PROCEDURAL BACKGROUND

         On May 5, 2016, Plaintiff Michelle Kindoll was arrested for possession of heroin. (Doc. # 73-6 at 20-21). Plaintiff's adult daughter, Felicia, was arrested as well, and the two women were ultimately transported to the GCDC for pretrial detention. (Docs. # 73-9 at 8, 24, 36-37, 121 and 73-6 at 10-14). During the GCDC intake process, Kindoll advised the staff that she would be experiencing withdrawal from heroin. (Docs. # 73-9 at 162 and 73-7 at 24-25).

         Plaintiff was then placed alone in an isolation cell to undergo withdrawal. (Docs. # 73-9 at 37-38 and 73-7 at 25). At the GCDC, isolation cells were used primarily for punishment purposes. (Docs. # 73-5 at 36 and 73-7 at 63). However, as the female “x-block” at the GCDC did not have medical-watch cells, jailers used these isolation cells at times for “medical watch” purposes such as keeping a closer eye on inmates undergoing drug withdrawal. Id. Inmates placed in isolation cells for medical watch were monitored more frequently; the jailer on shift was required to look in every ten to fifteen minutes. (Docs. # 73-5 at 49-50; 73-11 at 33 and 73-12 at 50-51). Likewise, medical staff checked vitals and conducted a basic overview once per twelve-hour shift for inmates on medical watch. (Docs. # 73-2 at 30-32 and 73-3 at 102).

         On May 9, 2016, Plaintiff's daughter was released on bond. (Doc. # 73-6 at 20-22). That same day, Plaintiff inquired when she would be moved out of the isolation cell into a general-population cell, as she was no longer experiencing withdrawal symptoms. (Doc. # 73-9 at 41, 146). Approximately two days later, on May 11, 2016, Plaintiff was cleared by medical staff to move to a general-population cell. (Docs. # 73-5 at 61 and 73-9 at 41-43).

         It appears that Plaintiff did not display any stroke symptoms while she was interned in the isolation cell for heroin withdrawal. (Doc. # 73-3 at 29). However, on approximately May 18, 2016, about two weeks after being detained at the GCDC, Plaintiff began experiencing stroke symptoms. (Docs. # 73-9 at 46 and 73-22 at 2). While housed in the general-population cell, Plaintiff felt weak and experienced obstructed vision; further, Plaintiff passed out in the shower, requiring other inmates to help Plaintiff back to her “boat”-a mat on the floor. (Docs. # 73-9 at 47 and 73-16). Plaintiff, however, did not seek medical treatment after passing out in the shower. She testified that she did not want to be “put . . . back in isolation.” (Doc. # 73-9 at 48-49). Further, Plaintiff testified that she experienced difficulty thinking clearly and did not understand that she was experiencing stroke symptoms; rather, she believed she had a “pinched nerve” or was “just . . . withdrawing.” Id. at 48-49, 55-56, 61, 153.

         As time progressed, however, GCDC staff and the medical team were alerted to Kindoll's symptoms. That same day on May 18, 2016, at approximately 6:15 p.m., after Plaintiff was moved to the general-population cell, she informed the day-shift deputy jailer, Dedi Adams, that she could not feel her leg. (Doc. # 73-5 at 26, 63). Deputy Adams notified Debbie Preston, LPN, in the medical unit that Plaintiff reported that she could not feel her leg. (Doc. # 73-18). Adams's Incident Report notes that LPN Preston said, “OK.” Id. However, LPN Preston did not assess Plaintiff at that time. (Docs. # 73-4 at 29-33; 73-5 at 63-64, 68, 72-73, 77 and 73-18).

         At the end of her shift, Deputy Adams communicated to the night-shift deputy jailer, Tammy Bullock, that Plaintiff said she could not feel her leg and to keep an eye on her. (Docs. # 73-5 at 64 and 73-11 at 20-21). Deputy Bullock's overnight shift lasted from 6:45 p.m. on May 18, 2016, to 7:15 a.m. on May 19, 2016. (Doc. # 73-11 at 15-18, 21, 25). During her shift, Bullock was alerted by other inmates that Plaintiff complained of “not full body movement.” Id. Bullock observed that Plaintiff was dragging her right leg and that Plaintiff complained of not being able to use or move her leg and having trouble seeing. (Docs. # 73-9 at 163; 73-11 at 19-21, 27-32, 36-38 and 73-16). Deputy Bullock also noted that the symptoms were irregular; at times during the night of May 18, 2016, the symptoms moved to Plaintiff's left leg; at other times, both legs were normal. Id. Additionally, Bullock observed that other inmates in the general-population cell were helping Plaintiff stand up, sit down, and walk to the bathroom. (Docs. # 73-11 at 21 and 73-16). Deputy Bullock notified medical staff and informed the on-duty nurse, David Ross, LPN, that Plaintiff had been limping and complained that she could not feel her foot. (Docs. # 73-2 at 76-77, 126-128, 152-153 and 73-11 at 15-17, 25).

         LPN Ross conducted an evaluation of Plaintiff and found her vital signs to be normal. Ross performed and improperly interpreted a “Babinski test” to look for neurological issues. Ross misinterpreted a positive indication as a negative, and failed to recognize a sign of any other health conditions. (Docs. # 73-2 at 68-77; 73-9 at 63; 73-16 and 73-10 at 52-54, 80-81, 83). Noting that Plaintiff had indicated on her intake form that she had back problems, Ross concluded that the numbness in Plaintiff's leg was merely sciatica and he chose not to reach out to his supervisor, Medical Team Administrator David Watkins, RN, or to the on-call physician. (Doc. # 73-2 at 72, 79, 86-87).

         LPN Ross testified that inmates who had more acute needs at the GCDC were not treated significantly different than patients who were on long-term medications or received chronic care. If he perceived that an inmate had a serious medical condition, Ross testified that he would not reach out to a physician immediately but would “[s]tart out by calling [Medical Team Administrator, Nurse David Watkins], asking him what he thinks. And then he would typically say, go ahead and call a doctor, or, I'll observe.” Id. at 48-50. On the day he assessed Plaintiff, Ross did not reach out to the Medical Team Administrator, David Watkins, nor did he contact the physician on call; rather, he put a note in the binder for the physician to review when he made his periodic visit the following week.[2] (Docs. # 73-2 at 72, 78-79 and 73-3 at 14).

         Shawnee Thoman, the regional representative for SHP-the corporation contracted by Grant County to ensure treatment guidelines were being adhered to- testified that it was the role of the physician to decide a patient's care. (Doc. # 73-10 at 12, 38-39). However, Thoman testified that she was not aware of the physician contracted to provide services at GCDC, Dr. Elton Amos, having any role in supervising the nursing staff other than phone calls to him by the nursing staff should they wish to discuss a patient's treatment. Id. at 37-38.

         After his evaluation and diagnosis of Plaintiff's condition, LPN Ross and Deputy Bullock decided to move Plaintiff back to an isolation cell to prevent inmates from hurting themselves or Plaintiff, as the other inmates were seen lifting and pulling on Plaintiff while helping her to and from the bathroom. (Docs. # 73-2 at 76-77; 73-9 at 63; 73-11 at 27-32 and 73-16). LPN Ross instructed Deputy Bullock to keep an eye on Plaintiff and to call the medical unit if there were any changes. (Doc. # 73-2 at 76-77). Plaintiff was placed into the isolation cell on May 18, 2016; however, there is no evidence that Deputy Bullock placed Plaintiff on medical watch. (Doc. # 73-7 at 56). The record indicates that Plaintiff, though in isolation, was not placed on medical watch until 10:50 p.m. on May 20, 2016. Id. On May 19, 2016, at the end of his shift, LPN Ross assessed Plaintiff again. He observed Plaintiff limp while walking, but concluded that her condition had not changed; Ross conducted a pass-down to LPN Debbie Preston for the next shift. (Doc. # 73-2 at 77-78, 81, 85).

         On her own in the isolation cell, Plaintiff had trouble standing and fell, causing bruises on her body; she also experienced trouble speaking and thinking clearly. (Doc. # 73-9 at 64-65, 67). Plaintiff testified that she wanted more medical attention and grew frustrated that nursing staff would not do more than take her vitals. During this time Corporal Jessica Helton observed Plaintiff repeatedly knock on the isolation cell door and ask for corrections officers because of medical concerns she had. (Docs. # 73-9 at 64-65 and 73-8 at 42). Plaintiff asked what she had done to be placed back in isolation, and was told it was for her own safety and the safety of others, not as punishment. (Docs. # 73-8 at 37, 73; 73-9 at 66 and 73-20). Plaintiff informed Corporal Helton that her leg would not move, that she could not walk, and that her speech was slurring. Plaintiff asked Corporal Helton what she could do to make it better. (Docs. # 73-8 at 27-28; 73-9 at 164 and 73-20). Corporal Helton saw that Plaintiff was able to lift her leg up in the air and back down and noted “[t]he speech that [Plaintiff] claimed to be messed up was also back to normal, she wasn't stuttering or slurring at this time.” (Doc. # 73-20). Helton concluded that Kindoll was merely being disruptive and “coming up with something.” However, she did contact the medical unit and advised that Plaintiff was having problems standing. (Docs. # 73-8 at 29-32, 34, 41 and 73-20).

         During the day shift on May 19, 2016, Deputy Adams called LPN Debbie Preston to Plaintiff's cell. Preston documented that Plaintiff “continues to complain of having a stroke.” (Docs. # 73-4 at 34-46 and 73-10 at 86-87). Preston conducted an assessment and concluded that Plaintiff's vitals were fine, though she did not record them. Nor did Preston review prior entries in Plaintiff's chart, review the protocol binder, or call either NP Washington or Dr. Amos. Id. Additionally, during her assessment of Plaintiff, just like LPN Ross, LPN Preston performed and improperly interpreted the Babinski test for neurological issues, interpreting a positive sign for neurological issues as a negative sign. (Docs. # 73-4 at 34-40 and 73-10 at 90-91).

         On May 20, LPN Preston assessed Plaintiff again and noted that Plaintiff was still complaining that she could not feel her leg and that she fell and that Plaintiff's right arm curled up at times. (Doc. # 73-4 at 59-64). Nonetheless, Preston observed that Plaintiff's vital signs were normal and “cleared” Plaintiff's condition. Id.

         During the shift change later in the day on May 20, day shift Corporal Jessica Helton informed night shift Deputy Whitney Jett that Plaintiff had been dragging her leg and complaining of numbness. Helton advised Jett that she had contacted medical several times throughout the day and that Plaintiff had been knocking on the cell window continuously. (Doc. # 73-12 at 31-32, 56-58). During her shift, Jett conducted medical checks on Plaintiff approximately every fifteen to twenty minutes. Id. at 80.

         At approximately 8:45 p.m. on May 20, Deputy Jett escorted Plaintiff from the isolation cell to a shower room to bathe. (Docs. # 73-12 at 64 and 73-19). Jett observed that Plaintiff was having trouble walking and dragged one of her legs behind her. After taking three or four steps, Plaintiff fell. Deputy Jett asked Plaintiff if she was all right and if she wanted to go to the medical unit. Plaintiff appeared to try to shake her head, but she did not speak. Deputy Jett seated Plaintiff on a chair in the shower room, shut the door, and then contacted the GCDC medical unit by phone. Id. After describing the situation to the on-duty nurse, Deputy Jett testified that she was instructed to follow up with the on-duty nurse if there were any changes. (Doc. # 73-12 at 65-66). Jett left the shower room for approximately fifteen to twenty minutes to allow Plaintiff time to shower. Id. at 52-56, 66.

         To take a shower, Plaintiff was required to repeatedly push a button as water flow automatically shut off periodically. However, Plaintiff found that she was unable to lift her arm from her position on the shower chair to keep the water on, and she only got her hair wet part of the way. She tried to stand up, then fell onto the floor and was unable to get up. (Doc. # 73-9 at 167). After about fifteen minutes, Deputy Jett asked Plaintiff if she was done. Plaintiff answered yes, so Deputy Jett opened the door to the shower and observed Plaintiff sitting on the floor, half dressed. (Docs. # 73-12 at 52-56, 66-68 and 73-19). Jett instructed Plaintiff that she needed to get dressed and could not exit the shower room partially clothed. Jett asked Plaintiff if she was all right and if she still wanted to take a shower, and Plaintiff nodded her head yes. (Doc. # 73-12 at 62).

         Concluding that something was wrong, Jett shut the door to the shower room and contacted her supervisor, Corporal Audra Napier, by radio. (Docs. # 73-12 at 52-56; 73-1 at 10, 14-15, and 73-19). As the highest-ranking officer on site during this shift, Corporal Napier was responsible for overseeing the safety and security of the facility and overseeing the jail, staff, and inmates. (Doc. # 73-1 at 9). Napier advised that she would be there momentarily. (Doc. # 73-12 at 52-56, 71).

         After radioing Corporal Napier, approximately ten minutes passed and Deputy Jett again opened the shower door to ask Plaintiff if she was ready. Though Plaintiff again said yes, Deputy Jett found Plaintiff still sitting on the floor in the same position, half dressed. (Docs. # 73-12 at 52-56, 70 and 73-19). Deputy Jett noted that Plaintiff for the most part made no response and just looked at Jett; at other times, it appeared Plaintiff was moving her mouth slightly to try to speak, but nothing was coming out. Plaintiff's bizarre behavior struck Jett as unusual and she was concerned that Plaintiff was not just experiencing routine drug withdrawal. (Docs. # 73-12 at 59, 61, 69-70, 82, and 73-19). Deputy Jett once again verbally instructed Plaintiff to get dressed. Jett closed the shower again and radioed Corporal Napier a second time, advising that Napier needed to come immediately. (Docs. # 73-12 at 52-56, 71 and 73-19).

         When Corporal Napier arrived a few minutes later, she opened the shower door and observed Plaintiff was sitting on the floor, half dressed, with the water off. (Docs. # 73-1 at 15-16; 73-9 at 169; 73-12 at 52-56 and 73-19). Napier advised that she would be taking Plaintiff to the medical unit, and she instructed Plaintiff to get dressed before coming out of the shower room to go to medical. (Docs. # 73-1 at 16-17; 73-12 at 52-56 and 73-19). Plaintiff appeared to try and get dressed, so Jett and Napier shut the shower door again to give her privacy. (Docs. # 73-1 at 18 and 73-12 at 52-56). Jett and Napier waited a few more minutes and opened the shower door again. They observed Plaintiff, partially dressed, and flailing her arms before falling from the shower chair onto the floor. (Docs. # 73-12 at 52-56; 72-77 and 73-19). Napier and Jett discussed that they needed to go ahead and get Plaintiff dressed and get Plaintiff to the medical unit immediately; accordingly, they helped Plaintiff get dressed by holding her clothes for her while she stepped into them. (Docs. # 73-1 at 15; 73-12 at 56-56, 77-78 and 73-19). Napier and Jett then assisted Plaintiff into a wheelchair. (Docs. # 73-12 at 78-79 and 73-19).

         By approximately 9:48 p.m. on May 20, 2016, about one hour after Plaintiff fell on her way to the shower, Corporal Napier transported Plaintiff to medical by wheelchair. Licensed Registered Nurse (RN) David Watkins was on shift and performed the assessment. (Docs. # 73-1 at 15; 73-3 at 7, 26, 81; 73-7 at 79; 73-12 at 78-79 and 73-19). During his assessment of Plaintiff, just like LPNs Ross and Preston, RN Watkins performed and improperly interpreted the Babinski test as negative for neurological issues; however, Watkins was able to recognize that Plaintiff was displaying stroke symptoms. (Doc. # 73-3 at 46-48, 96-101). Specifically, RN Watkins observed that Plaintiff was having trouble speaking, could not raise her arms equally, and could not write her name accurately. (Docs. # 73-3 at 26 and 73-10 at 92-94). Watkins did not consult with LPN Ross or LPN Preston about Plaintiff's condition; nor did he call Dr. Amos or NP Washington or send Plaintiff to the hospital. (Doc. # 73-3 at 30). Rather, it appears that at 10:51 p.m. on May 20, 2016, Plaintiff was taken back to an isolation cell and placed on medical watch. (Docs. # 73-3 at 52-56, 81; 73-12 at 79-80 and 73-19).

         Deputy Jett testified that she was surprised Plaintiff was sent back to x-block from medical because she felt like “something was still wrong.” (Doc. # 73-12 at 82). Jett was uncertain because she did not observe the assessment and had no medical experience; however, based on her observations, she grew concerned that the medical unit should have done something more and that simply continuing to monitor Kindoll by having a deputy checking in every 15 minutes was not sufficient. Id. at 82-84, 113-114. Jett shared her concern with Corporal Napier. Napier responded that she would “make some phone calls” and instructed Jett to keep an eye on Plaintiff. (Doc. # 73-12 at 84). Deputy Jett continued to look in Plaintiff's isolation cell every fifteen minutes, and observed that Plaintiff appeared to be sleeping. Id. at 86.

         In the early morning hours of May 21, 2016, RN Watkins decided to send Plaintiff to the hospital. (Doc. # 73-3 at 28, 50-51, 55-62). Corporal Napier returned to x-block and informed Deputy Jett that Plaintiff was going to the hospital. Napier assisted Plaintiff into the wheelchair and transported her out of x-block. (Doc. # 73-12 at 86-87). At about 1:47 a.m. on May 21, 2016-approximately three hours after Napier transported Plaintiff to medical by wheelchair-Plaintiff was taken to St. Elizabeth Grant County Hospital. (Docs. # 73-3 at 28, 50-51, 55-62 and 73-7 at 88).

         RN Watkins testified that he does not remember whether he placed Plaintiff back on “medical watch” in the isolation cell for the three hours Plaintiff waited prior to being transported to the hospital; however, he admitted that if he failed to act immediately, he violated the stroke protocol set forth in the SHP Treatment Guidelines. (Docs. # 73-3 at 81 and 73-10 at 102). The treatment protocol for recognition of a stroke or stroke symptoms required assessment for symptoms such as weakness in the face, arm, or legs, especially on one side of the patient's body; sudden confusion; sudden trouble seeing in one or both eyes; trouble speaking, or difficulty understanding speech; trouble walking; and dizziness, loss of balance, or lack of coordination. Moreover, the treatment protocol used the acronym “F.A.S.T” and cautioned that “[i]f you think someone is having a stroke, act F.A.S.T.” The letter “T” in the acronym stands for “Time.” The protocol notes that “[i]f you observe ANY of these signs, call 911/EMS-Acting fast can help stroke patients get the treatments they need.” (Docs. # 73-3 at 51-52 and 73-10 at 78-50).

         After being transported to the hospital, Plaintiff was informed that she had suffered multiple strokes. She testified that she suffers permanent injuries including impaired speech and mobility as a result. (Doc. # 73-9 at 83-84, 88-91, 153-156). Plaintiff's expert neurologist, David F. Lang, M.D., opined that had Plaintiff been transferred to the emergency room when she first reported her stroke symptoms the evening of May 18, 2016, more likely than not, Plaintiff would have been a candidate to receive interventional medicine before the treatment window closed and more likely than not would have been spared many of the deficits caused by the stroke. (Docs. # 83-1 at 6-7; 83-9 and 86-2 at 49-58, 67-69).

         Plaintiff presented evidence that the GCDC has a history of failing to provide the constitutionally-minimum medical treatment to inmates with serious or potentially serious acute medical conditions like strokes. Beginning in 2003, the United States Department of Justice (DOJ) initiated an investigation of the GCDC.[3] (Doc. # 73-26 at 1). On May 18, 2005, the DOJ reported its findings to the GCDC. (Doc. # 73-25). Among its findings, the DOJ concluded that the provision of acute medical care at GCDC “appears to deviate from constitutionally minimum standards” and specifically that “GCDC consistently fails to provide reasonable medical treatment to inmates with serious or potentially serious acute medical conditions.” (Doc. # 73-25 at 7).

         The DOJ found “a host of management deficiencies, ” including “the inadequate medical care at GCDC [which] appears to result primarily from the shortage of medical staff at the facility.” (Doc. # 73-25 at 10). The DOJ pointed out that “[a] physician on-site for two to three hours per week . . . is clearly insufficient to provide the medical care required for an institution the size of GCDC.” (Doc. # 73-25 at 10). Further, the DOJ found that GCDC “lacks policies on, inter alia, timeliness of access to medical care, ” or “protocols for the nurse or the correctional staff to use to ensure timely access to the physician when presenting symptoms requiring physician care.” Id. Moreover, “many of [the] facility's policies and procedures lack the breadth and specificity to form an infrastructure to ensure timely access to the appropriate level” of medical care. (Doc. # 73-25 at 12). Additionally the DOJ found that the GCDC failed to keep organized and sufficiently-detailed medical records, which contributed to the failure to provide adequate medical care. (Doc. # 73-25 at 12-13).

         In 2009, the Grant County attorney signed the DOJ's Proposed Resolution, which recognized improvements but also set forth “a few areas of remaining concern regarding the County's provision of medical and mental health care” which required “future oversight” by the DOJ. (Doc. # 73-26 at 5). The Proposed Resolution listed sixteen “remedial measures” for Grant County to implement, including an agreement that:

(2) The County will continue to provide sufficient on-site physician, mental health care provider, and nursing staff to ensure adequate medical care (including chronic and acute care). The County also will continue to provide sufficient on-site physician staffing to adequately supervise nursing staff.
(7) The County will continue to ensure that all inmates with serious or potentially serious acute medical conditions receive necessary examination, diagnosis, monitoring, and treatment, including referrals to appropriate outside medical professionals when clinically indicated.
(16) The County will continue to maintain on-site complete, confidential, and appropriately organized medical and mental health records for each inmate. The County will continue to ensure that such records include sufficient information (including symptoms, the results of physical evaluations, and medical staff progress notes) to ensure that health services staff have all relevant information available when treating inmates.

(Doc. # 73-26 at 2-4).

         On October 14, 2014, the DOJ provided the Grant County attorney with another assessment regarding conditions at GCDC. (Doc. # 73-13 at 2). The letter noted that “[i]n our last compliance letter, we acknowledged that a new Jail administration and contractor were in place [and] understood that they might not have had as much time to fully evaluate their obligations under the Agreement and take remedial action.” (Doc. # 73-13 at 14). The assessment went on to state, however, that “enough time has now passed that the County's lack of progress is much more troubling.” Id. The DOJ found that “the County has made little progress” in addressing the deficiencies identified in its August 3, 2009 Resolution, including a failure to provide prisoners “with adequate access to qualified clinical staff and mental health services.” (Doc. # 73-13 at 2).

         Aware of management issues at the GCDC, Christopher Hankins ran against the incumbent Jailer and was elected to the position in 2015. (Doc. # 73-7 at 5, 10-11). As the Jailer, Hankins has the final power to adopt policy for the jail, as well as the policy and procedure manual, and he has the final power to hire, fire, and discipline personnel. Id. at 18. Hankins also has the ultimate responsibility for determining if the deputy jailers are acting consistent with policy and making sure inmates are safe and secure. Id. at 62.

         In order to try to comply with the Department of Justice Resolution, Hankins hired contractor Southern Health Partners, Inc. (SHP), and SHP began providing medical care at the GCDC in the latter part of 2015. Id. at 28-29, 33, 35-36. Hankins testified that he and his staff met with SHP about coming into compliance with the DOJ agreement. Id. at 104-105. However, Jailer Hankins testified that he did not personally do anything to monitor the type of health care inmates were receiving at GCDC during the time SHP was the medical provider and that no one at Grant County had any responsibility for supervising the SHP medical staff. Id. at 32-33.

         Moreover, Jailer Hankins testified that he delegated the monitoring of the medical care provided by SHP to his brother, Major of Operations Jason Hankins. Id. at 15, 66- 67. Jailer Hankins testified that while he may have “skimmed through” the DOJ's August 3, 2009 Resolution (Doc. # 73-26), he has never seen the DOJ's May 18, 2005 findings (Doc. # 73-25). See (Doc. # 73-7 at 94, 97, 99). Further, Jailer Hankins testified that he is not aware how Jason Hankins monitored SHP and is not sure if Jason Hankins had any regular meetings with the medical staff from SHP, or received or reviewed any reports from SHP prior to Plaintiff's stroke. Id. at 29-32. Jailer Hankins testified that he does not recall any investigation into Plaintiff's incident at the GCDC, and to his knowledge no disciplinary action was taken against the SHP nurses or the GCDC employees as a result of the incident. Id. at 72, 70-72. The DOJ monitoring was ongoing at the time of Plaintiff's stroke, as the GCDC has not been found in compliance with the DOJ Resolution, and the record indicates that DOJ representatives were at GCDC for an inspection as recently as 2017. (Docs. # 73-7 at 93-94, 97, 102 and 73-10 at 44-46).

         II. ANALYSIS

         A. Standard of Review

         Summary judgment is appropriate when the record reveals “that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law.” Fed.R.Civ.P. 56(a). A genuine dispute of material fact exists where “the evidence is such that a reasonable jury could return a verdict for the nonmoving party.” Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 249 (1986). The “moving party bears the burden of showing the absence of any genuine issues of material fact.” Sigler v. Am. Honda Motor Co., 532 F.3d 469, 483 (6th Cir. 2008). Once a party files a properly-supported motion for summary judgment, by either affirmatively negating an essential element of the non-moving party's claim or establishing an affirmative defense, “the adverse party must set forth specific facts showing that there is a genuine issue for trial.” Anderson, 477 U.S. at 250. However, “the mere existence of a scintilla of evidence in support of the [non-moving party's] position will be insufficient.” Id. at 252.

         The Court must “accept Plaintiff's evidence as true and draw all reasonable inferences in [her] favor.” Laster v. City of Kalamazoo, 746 F.3d 714, 726 (6th Cir. 2014) (citing Anderson, 477 U.S. at 255). The Court may not “make credibility determinations” or “weigh the evidence when determining whether an issue of fact remains for trial.” Id. (citing Logan v. Denny's, Inc., 259 F.3d 558, 566 (6th Cir. 2001)). “The ultimate question is ‘whether the evidence presents a sufficient disagreement to require submission to a jury or whether it is so one-sided that one party must prevail as a matter of law.'” Back v. Nestle USA, Inc., 694 F.3d 571, 575 (6th Cir. 2012) (quoting Anderson, 477 U.S. at 251-52). If there is a dispute over facts that might affect the outcome of the case under governing law, the entry of summary judgment is precluded. Anderson, 477 U.S. at 248.

         As the moving parties in each of their respective motions, the County Defendants and SHP Defendants must shoulder the burden of showing the absence of a genuine dispute of material fact as to at least one essential element of each of Plaintiff's claims against which they seek dismissal. Fed.R.Civ.P. 56(c); see also Laster, 746 F.3d at 726 (citing Celotex Corp. v. Catrett, 477 U.S. 317, 324 (1986)). Assuming Defendants satisfy their burdens, Plaintiff must-by citing to “particular parts of materials in the record, including depositions, documents, electronically stored information, affidavits or declarations, stipulations . . . admissions, interrogatory answers, or other materials”- show specific facts that reveal a genuine issue for trial. Fed.R.Civ.P. 56(c)(1)(A); Laster, 746 F.3d at 726 (citing Celotex, 477 U.S. at 324). Furthermore, “the trial court no longer has a duty to search the entire record to establish that it is bereft of a genuine issue of material fact.” Street v. J.C. Bradford & Co., 886 F.2d 1472, 1479-80 (6th Cir. 1989).

         B. County Defendants' Motion for Summary Judgment

         The County Defendants assert four central arguments in support of their Motion for Summary Judgment.[4] First, Defendants argue that Plaintiff's official-capacity § 1983 claims against the individually-named Defendants should be dismissed as redundant because Plaintiff also named the County as a party. (Doc. # 62-1 at 11-15). Second, Defendants argue that Plaintiff's § 1983 claim against Grant County should be dismissed because Plaintiff failed to demonstrate the requisite “policy or custom” to invoke municipal liability. Id. at 26-29. Third, Defendants argue that Plaintiff's individual-capacity § 1983 claims against the individually-named defendants should be dismissed because qualified immunity bars the suit and because the defendants were not deliberately indifferent to Plaintiff's medical needs. Id. at 20-26; 29-37. Finally, Defendants argue that qualified immunity bars Plaintiff's state-law claim for negligence against the individually-named defendants. Id. at 12-20. Each argument will be addressed in turn. For the reasons set forth below, the County Defendants' Motion for Summary Judgment is granted in part and denied in part.

         1. Summary judgment is proper as to Plaintiff's § 1983 claim against the individually-named Defendants in their official capacities.

         The County Defendants' first argument asserts that the individually-named Defendants-Audra Napier, Tammy Bullock, Christopher Hankins, and John and Jane Doe[5]-are entitled to summary judgment as to Plaintiff's official-capacity claim under 42 U.S.C. § 1983 (Count One), because these claims are redundant to Plaintiff's claim against Grant County itself. (Doc. # 62-1 at 11). Plaintiff concedes that “her official capacity claims against the individual County defendants amount to a claim against Grant County, which was also named as a party.” (Doc. # 73 at 43). The Court agrees that “as a matter of housekeeping, ” because Plaintiff has brought suit against Grant County directly, “there is no longer a need to bring official-capacity actions against local government officials.” C.K. v. Bell Cty. Bd. of Educ., 839 F.Supp.2d 881, 884 (E.D. Ky. 2012) (citing Kentucky v. Graham, 473 U.S. 159, 165-67 (1985)). Accordingly, summary judgment is granted as to Plaintiff's official-capacity § 1983 claim against these Defendants.

         2. Summary judgment is proper as to Plaintiff's remaining claims against John and Jane Doe.

         Plaintiff named Defendants John and Jane Doe in Count One and Count Four of her Complaint. (Doc. # 1 at 2). As to Count One, in addition to conceding that dismissal is appropriate as to her official-capacity claim against each of the individually-named Defendants, Plaintiff has “put forth no arguments as to why the individual-capacity claim against [John and Jane] Doe should survive summary judgment analysis.”[6] Delong v. Arms, No. 06-77-GFVT, 2007 WL 4510323, at *9 (E.D. Ky. Dec. 21, 2007). Indeed, Plaintiff does “not once mention or allude to the individual-capacity claims against [John and Jane] Doe in [her] Response.” Id. Accordingly, because Plaintiff has failed to direct the Court to specific portions of the record that she asserts create a genuine issue of material fact, Plaintiff's § 1983 individual-capacity claim against John and Jane Doe fails and summary judgment is granted. See Id. See also Haverstick Enters., Inc. v. Fin. Fed. Credit, Inc., 32 F.3d 989, 996 (6th Cir. 1994) (finding that where a § 1983 action could not be asserted successfully against a Doe defendant, summary judgment is appropriately awarded).

         As to Count Four, Plaintiff has likewise failed to show why the negligence claim against John and Jane Doe should survive summary judgment analysis. Plaintiff failed to point to any materials in the record that show specific facts revealing a genuine issue for trial; without even a scintilla of evidence in support of her position, the Court will grant summary judgment to these Defendants on the negligence claim contained in Count Four of the Complaint. Copen v. Noble Cty., No. 2:13-cv-00610, 2016 WL 687593, at *5 (S.D. Ohio Feb. 19, 2016). See also Fed. R. Civ. P. 56(c)(1)(A); Laster, 746 F.3d at 726 (citing Celotex, 477 U.S. at 324).

         3. Defendant Grant County is not entitled to summary judgment as to Plaintiff's § 1983 claim.

         The County Defendants next argue that Defendant Grant County is entitled to summary judgment as to Plaintiff's claim under 42 U.S.C. § 1983 because Plaintiff has not demonstrated any “policy or custom” that caused her injury. (Doc. # 62-1 at 26). Defendants' argument fails. Accepting Plaintiff's evidence as true and drawing all reasonable inferences in her favor, see Anderson, 477 U.S. at 255, the Court finds that Plaintiff has set forth sufficient evidence of the requisite policy or custom to show that there is a genuine issue for trial. Celotex, 477 U.S. at 324.

         To impose municipal liability pursuant to 42 U.S.C. § 1983, a plaintiff must prove that a constitutional violation occurred and that the municipality is responsible for the violation. Ford v. Cty. of Grand Traverse, 535 F.3d 483, 498 (6th Cir. 2008) (internal citation omitted); Crouch v. S. Health Partners, Inc., No. 1:08-cv-P89-R, 2009 WL 860414 (W.D. Ky. Mar. 27, 2009) (citing Collins v. City of Harker Heights, Tex., 503 U.S. 115, 120 (1992)). Further, there must be a “direct causal link” between a municip a l po licy or c ustom and the alleged deprivation, and such policy or custom must be the “moving force” of the constitutional violation. Crouch, 2009 WL 860414, at *3 (citing Monell v. Dep't of Soc. Servs., 436 U.S. 658, 691 (1978)); see also Waters v. City of Morristown, 242 F.3d 353, 362 (6th Cir. 2001). Stated another way, a plaintiff must (1) identify the municipal policy or custom, (2) connect the policy to the municipality, and (3) show that the plaintiff incurred a particular injury due to execution of that policy. Alkire v. Irving, 330 F.3d 802, 815 (6th Cir. 2003) (citing Garner v. Memphis Police Dep't, 8 F.3d 358, 364 (6th Cir. 1993)). “These stringent standards are necessary to avoid de facto respondeat superior liability explicitly prohibited by Monell.” Graham v. Cty. of Washtenaw, 358 F.3d 377, 383 (6th Cir. 2004) (citing Doe v. Claiborne Cty., 103 F.3d 495, 508 (6th Cir. 1996)).

         The County Defendants argue that summary judgment as to Plaintiff's § 1983 claim against Grant County is proper because Plaintiff “has not pointed to any policy or custom that caused Plaintiff's injury.” (Doc. # 62-1 at 28). In order to demonstrate the requisite “municipal policy or custom” leading to the alleged violation, “a plaintiff can identify: (1) the municipality's legislative enactments or official policies; (2) actions taken by officials with final decision-making authority; (3) a policy of inadequate training or supervision; or (4) a custom of tolerance or acquiescence of federal violations.” Winkler v. Madison Cty., 893 F.3d 877, 901 (6th Cir. 2018) (citing Baynes v. Cleland, 799 F.3d 600, 621 (6th Cir. 2015)). Pointing to carefully-tailored selections of Plaintiff's deposition testimony, the County Defendants seek to frame Plaintiff's treatment at GCDC narrowly as an “isolated occurrence that affected only Plaintiff” rather than the result of the requisite “policy or custom.” (Doc. # 62-1 at 29). The County Defendants point to Plaintiff's testimony, for example, that she was not personally aware of GCDC's treatment protocols, she was not aware of any other inmates at GCDC who specifically suffered from a stroke, and that she was regularly seen by medical staff despite not expressly requesting medical care. (Doc. # 62-1 at 28-29).

         The County Defendants' selective citation of Plaintiff's deposition testimony alone, however, ignores a wealth of contrary evidence in the record that the failure to promptly treat Plaintiff's acute medical need was far from an isolated incident at GCDC. Rather, “[a] review of the record reveals a prison system in crisis.” Taylor v. Mich. Dep't of Corrs., 69 F.3d 76, 83 (6th Cir. 1995). First, Plaintiff's own lack of knowledge of the GCDC treatment protocol is irrelevant; it is the mental state of Defendants that is at issue in a § 1983 claim. See Winkler, 893 F.3d at 901-02. Defendants' assertion that Plaintiff did not expressly ask for medical assistance is equally unavailing in light of multiple witnesses' testimony that Plaintiff, though confused and limited at times in her ability to move, think, and speak, made the GCDC staff aware of her symptoms and actively sought help on numerous occasions prior to her hospitalization. See, e.g., (Docs. # 73-8 at 27-28, 42; 73-9 at 48-49, 55-56, 61, 64-65, 153, 164; 73-12 at 56-58 and 73-20).

         Further, while there is no evidence of other inmates who suffered from a stroke specifically, there is evidence that the delay in treating Plaintiff's acute condition was not a mere isolated incident. The record demonstrates DOJ findings that GCDC “lacks policies on, inter alia, timeliness of access to medical care, ” or “protocols for the nurse or the correctional staff to use to ensure timely access to the physician when presenting symptoms requiring physician care.” (Doc. # 73-25 at 12). As a result, the DOJ concluded that the provision of acute medical care at GCDC “deviates from constitutionally minimum standards” and that “GCDC consistently fails to provide reasonable medical treatment to ...


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