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Nature of Suit Code: 440
Nature of Suit: Other Civil Rights
Cause of Action: 

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NOT RECOMMENDED FOR FULL-TEXT PUBLICATION

File Name: 20a0034n.06

No. 19-5132

UNITED STATES COURT OF APPEALS

FOR THE SIXTH CIRCUIT

DANYEL O. MARTIN, Administratrix of the 

Estate of Edward T. Burke, IV, deceased,

Plaintiff–Appellant,

v.

WARREN COUNTY, KENTUCKY et al.,

Defendants,

SOUTHERN HEALTH PARTNERS, INC.; 

RONALD WALDRIDGE, MD, Individually; 

APRN BARRY DORITY, Individually; LPN 

TALANA LASLEY, Individually; LPN LYNN 

GRAY, Individually; TASHA HAFLEYCRANE, Individually,

Defendants–Appellees.

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ON APPEAL FROM THE 

UNITED STATES DISTRICT 

COURT FOR THE WESTERN 

DISTRICT OF KENTUCKY

OPINION

Before: MOORE, McKEAGUE, and LARSEN, Circuit Judges.

KAREN NELSON MOORE, Circuit Judge. Edward “Eddie” Burke died from an 

adrenal crisis that began while he was detained at the Warren County Regional Jail (“the WCRJ”) 

in Kentucky. His mother and the administratrix of his estate, Plaintiff-Appellant Danyel O. Martin, 

raised claims of inadequate medical care under the Fourteenth Amendment’s Due Process Clause,

pursuant to 42 U.S.C. § 1983, and state-law claims against the county, county officials, Southern 

Health Partners, Inc. (“SHP”), and SHP employees involved in Burke’s medical care during his 

detention. Defendants-Appellees SHP and its employees Dr. Ronald Waldridge, MD; Barry 

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Dority,1 APRN; Talana Lasley, LPN; Lynn Gray, LPN; and Tasha Hafley-Crane (“Crane”)

(collectively “the SHP defendants”) filed a motion for summary judgment. The district court 

granted the motion. On appeal, Martin argues that the district court (1) applied the wrong standard 

for deliberate-indifference claims brought by pretrial detainees in light of Kingsley v. Hendrickson, 

135 S. Ct. 2466 (2015), and (2) erred in granting the motion because there are genuine issues of 

material fact under either the current standard or one set forth by Kingsley. Martin fails to 

demonstrate that material fact disputes exist. Thus, we AFFIRM the district court.

I. BACKGROUND

A. The Medical Services Program at the Warren County Regional Jail

At the time of Burke’s pretrial detention, the WCRJ contracted with SHP to provide 

medical care to inmates. SHP hired Dr. Waldridge to serve as its Medical Director. R. 41-5 

(Waldridge Contract). He was responsible for the operation of the medical-services program at 

the WCRJ. Id. at 2–4 (Page ID #3435–37); see also R. 41-1 (SHP Policies and Procedures at 12)

(Page ID #3167). He was required to “provide professional medical services in combination with 

other physicians to assure that there is a physician on site at the [WCRJ] each week for 

approximately one to three hours.” R. 41-5 (Waldridge Contract at 2) (Page ID #3435). Later, an 

addendum was added, providing that Dr. Waldridge “or his designee will visit [the WCRJ] on a 

weekly basis up to 5 hours, as well as take call from the SHP site medical staff when needed.” 

R. 41-6 (Waldridge Contract Addendum at 1) (Page ID #3443).

To assist with his responsibilities, Dr. Waldridge hired Dority, an advanced practice 

registered nurse (“APRN”), who was responsible for conducting weekly visits to the jail, reviewing 

1Dority’s name is spelled inconsistently in the record. We use “Dority” because it appears to be the correct 

spelling. See, e.g., R. 32-1 (Jail Admission Report at 2) (Page ID #1862).

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medical services provided by staff, and seeing patients. R. 34-10 (Waldridge Dep. at 54) (Page ID 

#2824). Under this arrangement, Dr. Waldridge visited the WCRJ, which housed 350 to 400 

inmates, once each quarter. R. 26-7 (Waldridge Dep. at 19–20) (Page ID #1081). SHP also 

employed licensed practical nurses (“LPNs”) and other staff, such as medical technicians. There 

was always at least one LPN and one medical technician at the jail, and either Dr. Waldridge or 

Dority were available by phone. See R. 26-6 (Lasley Dep. at 34) (Page ID #1076); R. 26-10 (Gray 

Dep. at 12) (Page ID #1253).

B. Burke’s Detention and Treatment

Burke began his pretrial detention on November 5, 2015, after he was arrested for a parole 

violation. R. 32-1 (Jail Admission Report at 1) (Page ID #1861). He was twenty years old, id.; he 

turned twenty-one during his detention, see id. When he was admitted, he informed medical staff 

that he had diabetes, Addison’s disease, and a history of substance abuse. R. 26-3 (Medical Staff 

Receiving Screening Form at 2) (Page ID #863). He also reported that he was taking medications 

for Type 1 Diabetes and Addison’s disease, including insulin and prednisone, respectively. See 

id.; R. 26-2 (Martin Dep. at 18) (Page ID #858) (noting that Burke had Type 1 Diabetes).

The interaction of Burke’s two chronic diseases, Type 1 Diabetes and Addison’s disease, 

is especially relevant to this case. Burke had what is known as “brittle” diabetes, meaning that he 

suffered from drastic swings in his blood-sugar level across short periods of time, which were 

difficult to manage. R. 26-4 (Dahring Dep. at 78) (Page ID #942). “Addison’s disease is ‘a chronic 

type of adrenocortical insufficiency . . . . It . . . results in [a] deficiency of aldosterone and cortisol

. . . .’” Martin v. S. Health Partners, Inc., No. 1:17-CV-00020-GNS-HBB, 2019 WL 539064, at 

*1 n.2 (W.D. Ky. Feb. 11, 2019) (last alteration in original) (quoting Goldstein v. McDonald, No. 

15-1250, 2016 WL 1458490, at *1 n.1 (Vet. App. Apr. 14, 2016)). Addison’s disease can cause 

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an Addisonian, or adrenal, crisis, which may “lead to severe low blood pressure, severe weakness, 

and even death.” R. 34-10 (Waldridge Dep. at 88) (Page ID #2858). The exact cause of these 

crises is unclear, but stress and infection can trigger one. Id. at 88–89 (Page ID #2858–59). 

Addison’s disease is treated with corticosteroids, id. at 89 (Page ID #2859), such as prednisone in 

Burke’s case, R. 26-3 (Medical Staff Receiving Screening Form at 2) (Page ID #863). 

Corticosteroids, however, increase blood-sugar levels, R. 34-10 (Waldridge Dep. at 89) (Page ID 

#2859), which is problematic for a person with insulin-dependent diabetes. Thus, the treatment of 

Burke’s diabetes was complicated by the treatment of his Addison’s disease.

To manage his diabetes, the SHP staff administered short- and long-term insulin. There 

were standing orders at the top of each blood-sugar flow sheet that Burke should receive a dose of 

long-term insulin in the morning and at night. E.g., R. 26-11 (Blood Sugar Flow Sheets at 2) (Page 

ID #1257). The staff also read his blood-sugar level throughout the day to assess if and when he 

should receive short-term insulin and how much based on a sliding scale. R. 26-13 (Crane Dep. 

at 51–52) (Page ID #1290). Burke’s blood-sugar level was checked at least three times a day, after 

each meal. See R. 26-4 (Dahring Dep. at 96–97) (Page ID #960–61) (four times); R. 34-5 (Gray 

Dep. at 51) (Page ID #2372) (three times); see generally R. 26-11 (Blood Sugar Flow Sheets). 

Sometimes, he would also be given glucose tablets and/or juice if his blood-sugar level was low. 

See, e.g., R. 26-11 (Blood Sugar Flow Sheets at 3) (Page ID #1258). It is undisputed that Burke’s 

blood-sugar level fluctuated rapidly, that short-term insulin was administered at irregular times, 

see R. 26-11 (Blood Sugar Flow Sheets), and that Burke would sometimes refuse short-term 

insulin or request that it be reduced, see R. 26-13 (Crane Dep. at 52–53) (Page ID #1290); R. 26-

17 (Refusal of Medical Treatment and Release of Responsibility Dec. 13, 2015) (Page ID #1364).

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During Burke’s detention, he suffered incidents related to his diabetes. On November 8, 

2015, emergency medical services were called because his blood-sugar level was too low—it was 

recorded as “22.”

2 R. 26-16 (Progress Notes at 6) (Page ID #1360). On January 9, 2016, Burke 

alerted staff that he thought he had gone into a diabetic coma, and staff monitored him. Id. at 4 

(Page ID #1358). Eleven days later, on January 20, 2016, Burke notified staff that he felt like he 

was going to pass out, his blood-sugar level was again recorded as low, “37,” and staff gave him 

glucose tablets. Id.

Regarding Burke’s Addison’s disease, it is undisputed that he was not given his prescribed 

daily prednisone dose for more than two months. Dority directed that Burke receive daily 

prednisone during an appointment in early January. R. 34-4 (Dority Dep. at 52–53) (Page ID 

#2224–25); R. 26-14 (Medication Administration Record at 3) (Page ID #1296). After this, Burke 

received prednisone until he was transferred to the hospital on January 31, 2016, except when he 

refused it on January 30, 2016. See R. 26-18 (Refusal of Medical Treatment and Release of 

Responsibility Jan. 30, 2016) (Page ID #1366).

Burke refused this dose of prednisone because he believed that his blood-sugar level was 

too high and that the prednisone would raise it further. See id. Crane, a medical technician, gave 

him a refusal-of-treatment form that she filled out and Burke signed. See id. Although the form 

indicated that Burke was counseled about the risks of refusing his prednisone, id., it is undisputed 

that he was not counseled by SHP staff, Appellant Br. at 25; see Appellee Br. at 17–21, 44, 50–51 

(raising other arguments but not contesting that SHP staff failed to counsel Burke upon his refusal).

2

“Normal fasting blood sugar level is between 70 and 100 mg/dl.” Appellant Br. at 11 n.2; see also R. 26-

11 (Blood Sugar Flow Sheets at 2) (Page ID #1257) (noting that normal fasting blood-sugar levels are “less than 110”).

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On January 31, 2016, Burke’s blood-sugar level fluctuated. At 6:15 a.m., his blood-sugar 

level was above average, “374.” R. 26-11 (Blood Sugar Flow Sheets at 2) (Page ID #1257). Then 

he was given short- and long-term insulin. Id.; R. 34-3 (Crane Dep. at 25) (Page ID #2100). At 

11:07 a.m., Burke’s blood-sugar level was “72.” R. 26-11 (Blood Sugar Flow Sheets at 2) (Page 

ID #1257). Burke requested his blood-sugar level be checked at 2:25 p.m., and Crane did so. R. 

26-13 (Crane Dep. at 57–58) (Page ID #1291–92). It was “296.” R. 26-11 (Blood Sugar Flow 

Sheets at 2) (Page ID #1257). Crane told Gray, the LPN on duty, about Burke’s blood-sugar level. 

R. 34-3 (Crane Dep. at 31–33) (Page ID #2106–08). Gray decided not to give him insulin because 

“[w]e are still a little out from supper, we don’t want to bottom his sugar completely out,” but that 

they would “recheck it in a little bit.” Id. at 33 (Page ID #2108). She did not examine Burke or 

his medical chart. Crane informed Burke of Gray’s decision. R. 26-13 (Crane Dep. at 58) (Page 

ID #1292).

At 3:23 p.m., Burke collapsed. R. 26-16 (Progress Notes at 4) (Page ID #1358). Efforts 

to revive him were unsuccessful, id., and he was transferred to the hospital, R. 26-19 (Hospital 

Detail Activity Log at 7) (Page ID #1373). After a period on life support, Burke died on February 

1, 2016. R. 15-3 (Pfalzgraf Report at 1) (Page ID #131). The cause-of-death medical expert Dr.

Robert R. Pfalzgraf opined that Burke died from an Addisonian crisis brought on by missing his 

dose of prednisone on January 30, 2016 after regularly taking it since January 8, 2016.

3

 Id. at 2 

(Page ID #132).

3We do not know why Burke did not suffer an Addisonian crisis when he was admitted to the WCRJ and 

stopped receiving prednisone. However, Martin does not raise on appeal the apparent failure of the SHP defendants 

to provide prednisone for the first two months of his detention.

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C. Procedural History

As the administratrix of Burke’s estate, Martin filed a complaint alleging that the county, 

county officials, SHP, and SHP employees violated Burke’s right to adequate medical care under 

the Fourteenth Amendment’s Due Process Clause and were negligent under state law. R. 1 

(Compl.) (Page ID #1–17). All county defendants were dismissed, as were four other LPNs 

employed by SHP, pursuant to agreed orders of dismissal. R. 17 (First Agreed Order of Dismissal) 

(Page ID #138) (dismissing county and county officials); R. 43 (Second Agreed Order of 

Dismissal) (Page ID #3463) (dismissing other LPNs). The remaining defendants, the SHP 

defendants, filed a motion for summary judgment. R. 26 (Mot. for Summary J.) (Page ID #826). 

The district court granted the motion, declining to apply a new standard for deliberate-indifference 

claims brought by pretrial detainees based upon Kingsley, limiting Martin’s claims to claims 

related to the missed prednisone dose, and concluding that Martin failed to meet her burden at 

summary judgment to show material issues of fact existed to demonstrate deliberate indifference 

and causation. Martin, 2019 WL 539064, at *3–6. This appeal timely followed. See R. 46 (Notice 

of Appeal) (Page ID #3479). An amicus brief was filed by the Roderick and Solange MacArthur 

Justice Center, addressing the proper standard for deliberate-indifference claims brought by 

pretrial detainees in the wake of Kingsley.

II. STANDARD OF REVIEW

We review district court grants of summary judgment de novo, viewing all evidence in the 

light most favorable to the nonmoving party and drawing all reasonable inferences in the 

nonmoving party’s favor. Sec’y of Labor v. Timberline S., LLC, 925 F.3d 838, 843 (6th Cir. 2019) 

(citing Pearce v. Chrysler Grp. LLC Pension Plan, 893 F.3d 339, 345 (6th Cir. 2018)). Summary 

judgment is appropriate if there is no genuine dispute as to any material issue of fact. Matsushita 

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Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 585–87 (1986); Fed. R. Civ. P. 56(a). To 

meet her burden at summary judgment, “[t]he nonmoving party ‘must set forth specific facts 

showing that there is a genuine issue for trial.’” Pittman v. Experian Info. Sols., Inc., 901 F.3d 

619, 628 (6th Cir. 2018) (quoting Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 250 (1986)). If 

“the evidence presents sufficient disagreement to require submission to a jury,” there is a genuine 

issue of material fact. Anderson, 477 U.S. at 251–52.

III. INADEQUATE MEDICAL CARE

To succeed on a § 1983 claim, “a plaintiff must prove ‘(1) the deprivation of a right secured 

by the Constitution or laws of the United States (2) caused by a person acting under the color of 

state law.’” Shadrick v. Hopkins County, 805 F.3d 724, 736 (6th Cir. 2015) (quoting Jones v. 

Muskegon County, 625 F.3d 935, 941 (6th Cir. 2010)). Private companies (and their employees)

that perform traditional state functions, such as providing medical care to inmates, are state actors 

“for the purposes of § 1983.” Winkler v. Madison County, 893 F.3d 877, 890 (6th Cir. 2018) 

(citing Harrison v. Ash, 539 F.3d 510, 521 (6th Cir. 2008)). Common law tort principles govern 

causation in the § 1983 context. Powers v. Hamilton Cty. Pub. Defender Comm’n, 501 F.3d 592, 

608 (6th Cir. 2007) (citing McKinley v. City of Mansfield, 404 F.3d 418, 438 (6th Cir. 2005)).

As our precedent stands, we analyze pretrial detainees’ Fourteenth Amendment claims of 

deliberate indifference under the same framework for deliberate-indifference claims brought by 

prisoners pursuant to the Eighth Amendment, including claims of inadequate medical care. See 

Jones, 625 F.3d at 941 (quoting Blackmore v. Kalamazoo County, 390 F.3d 890, 895 (6th Cir. 

2004)). A claim of deliberate indifference to serious medical needs has two components—

objective and subjective. Winkler, 893 F.3d at 890. To satisfy the objective component, a pretrial 

detainee must show that he had a “sufficiently serious medical need.” Id. (quoting Spears v. Ruth, 

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589 F.3d 249, 254 (6th Cir. 2009)). As to the subjective component, a pretrial detainee must 

demonstrate that the defendants “have ‘a sufficiently culpable state of mind in denying medical 

care.’” Jones, 625 F.3d at 941 (quoting Blackmore, 390 F.3d at 895); see generally id. (quoting 

Farmer v. Brennan, 511 U.S. 825, 837 (1994)) (specifying what a plaintiff must prove to satisfy 

the subjective component).

On appeal, Martin argues that the district court applied the wrong standard to her 

deliberate-indifference claims in light of Kingsley, but she does not meet her burden at summary 

judgment for reasons that do not depend on the standard for evaluating pretrial detainees’ 

deliberate-indifference claims. She provides verifying medical evidence of a serious medical 

injury only for Burke’s missed dose of prednisone, his death, and so she cannot proceed on claims 

unrelated to that injury. But her brief focuses on the general treatment of Burke’s diabetes, and so 

she fails to point to relevant, specific facts demonstrating a question for the jury. On her remaining 

claims against the individual defendants, Martin fails to demonstrate a factual dispute as to 

causation, or when she does, she does not show conduct beyond negligence.

4

 Her briefing also 

fails to provide more than unadorned assertions in support of her claims against Dr. Waldridge for

supervisory liability and against SHP. In short, the brief’s focus on alleged injuries that are 

unsupported by verifying evidence, as required at this stage of litigation, means that Martin points 

4Martin argues that Kingsley requires an objective reasonableness standard. Appellant Br. at 34–35. But see 

Amicus Br. at 6 (arguing that the proper standard is objective deliberate indifference). In Kingsley, the Court held 

that a pretrial detainee’s Fourteenth Amendment excessive-force claim was governed by an objective standard, 

specifically objective reasonableness. 135 S. Ct. at 2472–73. Whether an objective standard applies to pretrial 

detainee claims of deliberate indifference and what the standard entails are open questions, though we have noted that 

Kingsley “calls into serious doubt” the application of the subjective component of the deliberate-indifference test 

usually applied to pretrial detainees’ claims. Richmond v. Huq, 885 F.3d 928, 938 n.3 (6th Cir. 2018). But see Winkler, 

893 F.3d at 890 (failing to address Kingsley). Whatever Kingsley requires, it is more than negligence. 135 S. Ct. at 

2472 (“[L]iability for negligently inflicted harm is categorically beneath the threshold of constitutional due process.” 

(emphasis in original) (quoting County of Sacramento v. Lewis, 523 U.S. 833, 849 (1998))). Because Martin at best 

shows negligent conduct when she does not otherwise fail to make a showing of causation, we leave the Kingsley 

question for another day.

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to few facts that align with her claims premised upon Burke’s missed dose of prednisone. 

Accordingly, Martin fails to satisfy her burden.

A. Verifying Medical Evidence

To satisfy the objective component, a plaintiff must identify a serious medical need, which 

is “one ‘that has been diagnosed by a physician as mandating treatment or one that is so obvious 

that even a lay person would easily recognize the necessity for a doctor’s attention.’” Jones, 625 

F.3d at 941 (quoting Harrison, 539 F.3d at 518). When a serious medical need is obvious, a 

plaintiff does not need to provide verifying medical evidence of harm. Blackmore, 390 F.3d at 

899–900 (quoting Gaudreault v. Municipality of Salem, 923 F.2d 203, 208 (1st Cir. 1990)). But 

when a serious medical need is not obvious and “is based on the prison’s failure to treat a condition 

adequately, or where the prisoner’s affliction is seemingly minor or non-obvious,” plaintiffs must

supply medical proof of injury at summary judgment so that we are able “to assess whether the 

delay [in adequate medical care] caused a serious medical injury.” Id. at 898 (citing Napier v. 

Madison County, 238 F.3d 739, 742 (6th Cir. 2001)). This includes claims of “delayed 

administration of medication,” “a prisoner’s refusal to take the prescribed medication,” and 

“occasional missed doses of medication.” Id. at 897.

Several examples are illustrative. To demonstrate that a delay in dialysis treatment was an 

objectively serious medical need, the plaintiff in Napier was required to provide evidence that the

delay harmed his kidney condition. 238 F.3d at 742–43. But appendicitis accompanied by 

“obvious manifestations of pain and injury,” including long bouts of intense stomach pains and 

the plaintiff’s verbal and written complaints of pain over the course of two days, was an obviously

serious medical risk that did not require verifying medical evidence. Blackmore, 390 F.3d at 899. 

Most relevantly, we concluded in Garretson v. City of Madison Heights that a plaintiff’s claim 

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about the adequacy of care she received for her insulin-dependent diabetes required verifying 

medical evidence of harm. 407 F.3d 789, 797 (6th Cir. 2005). There, the plaintiff satisfied her 

burden by providing proof that she was hospitalized for several days after missing her physicianmandated treatment—insulin injections. Id.

Martin’s claims about the treatment of Burke’s diabetes and Addison’s disease are 

controlled by Napier. Like the Garretson plaintiff, Burke required regular doses of medication—

insulin and prednisone—and Martin argues that Burke did not receive what he was prescribed as

it was supposed to be administered. Thus, her claims are about the adequacy of treatment. She 

must provide verifying medical evidence that the treatment Burke received for his diabetes and 

Addison’s disease caused him serious medical injury.

The parties agree that Martin has provided verifying medical evidence as to the missed 

prednisone dose. Martin offered Dr. Pfalzgraf’s report and testimony, in which he opined that 

Burke’s missed dose of prednisone led to an adrenal crisis that caused his death. However, Martin 

has not put forth evidence verifying that a serious medical injury resulted from the general 

treatment of Burke’s diabetes or Addison’s disease,

5

including the treatment he received on 

January 31, 2016. Therefore, we proceed to consider only Martin’s arguments pertaining to the 

prednisone dose that Burke missed on January 30, 2016.

Martin argues that she does not need to put forth verifying evidence of injury for her claims 

about the treatment of Burke’s diabetes because his serious medical need was obvious. See Reply 

Br. at 9, 14–15. Yet Martin does not distinguish her delay-in-adequate-care claim based on 

5Although Martin does not appear to challenge the SHP defendants’ failure to administer prednisone, it is 

less clear if she challenges the management of Burke’s Addison’s disease in her various claims that address the failure 

of the SHP defendants to follow their protocols and policies. To the extent that she does, we dispose of those claims

here.

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Burke’s brittle diabetes from the delay-in-adequate-care claim based upon diabetes in Garretson. 

In fact, Martin asserts elsewhere that Burke’s conditions were objectively serious not because they 

were obvious, but because they “had been diagnosed by a physician as mandating treatment,” and 

she cites Garretson for this proposition. Appellant Br. at 36. Even putting Garretson aside, 

Burke’s brittle diabetes was not an obviously serious medical need. A layperson could not easily

determine when Burke needed a doctor and what harm he suffered from a delay in treatment due 

to the drastic, but still typical, blood-sugar fluctuations and other symptoms of brittle diabetes.

6

 

See Blackmore, 390 F.3d at 899 (distinguishing appendicitis from a kidney condition in Napier

“where the injury to the prisoner’s kidney condition could not be discerned without competent 

medical proof”). And nothing in the record about the events on January 31, 2016 demonstrates 

that Burke’s serious medical need transformed into an obvious one prior to his loss of 

consciousness.7 Therefore, we cannot consider Martin’s arguments based upon the SHP 

defendants’ treatment of Burke’s diabetes.

6Martin refers to pain and suffering as a harm from the delay in adequate treatment of Burke’s diabetes, 

Appellant Br. at 19–20, and points to the testimony of the standard-of-care expert, Renee Dahring, Reply Br. at 9. 

Dahring testified that the decisions Gray made on January 31, 2016 would have caused Burke “discomfort, anxiety

. . . suffering . . . [and] fear.” R. 26-4 (Dahring Dep. at 119) (Page ID #983). Assuming arguendo that this is an 

adequate showing, Martin does not point to facts that show that Gray’s conduct was more than negligent. Despite 

Martin’s characterizations that Gray “did nothing” on January 31, 2016 when Burke requested insulin, Appellant Br. 

at 28 (emphasis omitted), the record reflects that Gray decided to decline Burke’s request because she was concerned 

that giving him the requested insulin would cause his blood sugar level to drop too low, supra Section I.B. This is 

“disagreement . . . over the proper course of treatment,” which is “at most, a medical-malpractice claim,” and so it “is 

not cognizable under § 1983.” Darrah v. Krisher, 865 F.3d 361, 372 (6th Cir. 2017) (citing Estelle v. Gamble, 429 

U.S. 97, 107 (1976)); see also id. (“Additionally, ‘[w]here a prisoner has received some medical attention and the 

dispute is over the adequacy of the treatment, federal courts are generally reluctant to . . . constitutionalize claims 

which sound in state tort law.’” (quoting Westlake v. Lucas, 537 F.2d 857, 860 n.5 (6th Cir. 1976))).

7Martin does not challenge the care that Burke received from this point on, including efforts to resuscitate 

him and his transfer to the hospital.

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B. Lasley, Gray, Dority, and Dr. Waldridge (Individual Capacity)

Martin fails to demonstrate a material fact dispute as to causation for her claims against 

Lasley, Gray, Dority, and Dr. Waldridge as an individual. As an initial matter, Martin’s brief does 

not address causation by name; in some instances, it also does not attempt to attribute complained 

of conduct to the individual defendant who acted. See Appellant Br. at 36–37. Martin argues that 

Lasley and Gray violated their “scope[s] of practice” by giving Burke medications for scabies and 

heartburn without consulting Dr. Waldridge or Dority about the possible effects of the medications 

on Burke’s diabetes or Addison’s disease. Id. at 23–24 (identifying the medications), 38. But she 

does not link Lasley’s and Gray’s decisions to the missed dose of prednisone. For her claims 

against Dority, Martin addresses only diabetes-based claims in her brief, which we do not consider

further, as explained above. Id. at 36–38.

Regarding her claim against Dr. Waldridge, Martin also argues that he did not prepare a 

Special Needs Treatment Plan for Burke or personally monitor him and that Dr. Waldridge

maintained an unconstitutional business model by breaching his contract with SHP by delegating 

his scheduled visits to the WCRJ to Dority.8 Id. at 36–38, 42. However, she does not demonstrate 

that Dr. Waldridge’s conduct caused Burke to miss his dose of prednisone. For example, Martin’s

brief does not show how a treatment plan or personal monitoring would have prevented Burke 

from skipping his dose of prednisone or how Dr. Waldridge’s “business model” caused Burke to 

miss his dose of prednisone. In sum, Martin fails to provide specific facts demonstrating causation 

or facts from which we could infer causation; she hopes that we will infer causation from nothing, 

but, without more, the only inferences we can draw are too attenuated to support causation.

8Martin misrepresents the record. The addendum to Dr. Waldridge’s contract noted that he could send a 

designee to visit the WCRJ.

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C. Crane

For her claim against Crane, Martin does not demonstrate that a genuine issue of material 

fact exists. She argues that “Crane failed to inform anyone of Burke’s refusal of his Prednisone 

on January 30, even though the refusal-of-treatment form she filled out required Waldridge’s 

signature” and for Burke to be apprised of the risks of refusing the prednisone.9 Appellant Br. at 

38; see also Reply Br. at 17–18. The failure to adhere to policies, without more, is only negligence. 

Winkler, 893 F.3d at 891–92. Martin provides no other facts that show Crane was more than 

negligent, such as, but not limited to, what she knew or should have known as a medical technician 

about the risk of Burke’s refusal. This is insufficient at the summary-judgment stage.

D. Doctor Waldridge (Supervisory Capacity)

Martin fails to meet her burden at summary judgment for her supervisory-liability claim 

against Dr. Waldridge. She argues that Dr. Waldridge failed to supervise the nurses to ensure that 

they complied with policies and procedures for transfers and inappropriately delegated his duty to 

do so to Dority. Appellant Br. at 39–40. For supervisory liability to attach, Martin must 

demonstrate that Dr. Waldridge “implicitly authorized, approved or knowingly acquiesced in the 

unconstitutional conduct of the offending subordinate.” Coley v. Lucas County, 799 F.3d 530, 542 

(6th Cir. 2015) (emphasis omitted) (quoting Taylor v. Mich. Dep’t of Corr., 69 F.3d 76, 81 (6th 

Cir. 1995)). This claim depends on unconstitutional conduct of subordinates, and Martin has not 

demonstrated a material issue of fact for her constitutional claims against Lasley, Gray, Dority, or 

Crane. Moreover, Martin makes no effort to satisfy the knowledge component. Although her brief 

cites Taylor for the proposition that supervisors cannot abandon their duties “in the face of actual 

9At oral argument, Martin’s counsel clarified that this is an argument that Crane failed to follow a policy, not 

that she should have advised Burke herself.

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knowledge of a breakdown in the proper workings of the department,” Appellant Br. at 40 (quoting 

Taylor, 69 F.3d at 81), she does not point to facts that indicate that there was, in fact, a breakdown 

in the proper workings of the medical services program’s hospital transfers and that Dr. Waldridge 

knew it. The brief cites legal rules, but does not supply relevant, specific facts to which it can 

apply them. Martin has not shown a material issue of fact as to her supervisory-liability claim 

against Dr. Waldridge.

E. Southern Health Partners

Martin argues that SHP failed to supervise Dr. Waldridge and to ensure that he fulfilled 

SHP’s policies, failed to train and supervise its employees about its policies and procedures, and

maintained an unconstitutional business model. Appellant Br. at 39–43. Although Martin frames 

her claims against SHP as one for supervisory liability, her claims are against an entity, and so we 

construe them as claims premised upon entity liability pursuant to Monell v. Department of Social 

Services, 436 U.S. 658 (1978). See Shadrick, 805 F.3d at 738 & n.6. We interpret her arguments

as ones that SHP had a custom or policy of failing to train or supervise its employees, including 

Dr. Waldridge, and of maintaining an unconstitutional business model.

To defeat summary judgment on a failure-to-train claim, Martin must show that “(1) the 

training or supervision was inadequate for the tasks performed; (2) the inadequacy was the result 

of the [entity’s] deliberate indifference; and (3) the inadequacy was closely related to or actually 

caused the injury.” Winkler, 893 F.3d at 902 (quoting Ellis ex rel. Pendergrass v. Cleveland Mun. 

Sch. Dist., 455 F.3d 690, 700 (6th Cir. 2006)). Martin does not address how SHP’s failure to train 

its employees, including Dr. Waldridge, as to the policies that she enumerates—most of which she 

connects to the treatment of Burke’s diabetes—caused Burke to miss his dose of prednisone. For 

instance, Martin argues that Lasley did not know why Dr. Waldridge should “establish a clinical

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treatment plan,” Appellant Br. at 40–41, but we cannot guess how Lasley’s lack of training about 

Dr. Waldridge’s responsibilities caused Burke to miss his dose of prednisone. Viewing the record 

in the light most favorable to Martin, the record shows that had SHP trained its staff on the 

specified policies, staff would have had to fill out more forms setting Burke’s baseline of care and 

recording his progress, particularly for his diabetes. See id. at 15–19. However, there is no 

indication how following these policies would have prevented Burke’s missed dose of prednisone.

Finally, Martin argues that SHP maintained an unconstitutional business model by 

breaching its contract with the WCRJ. Id. at 42–43. She provides no legal authority in support of 

this theory of Monell liability, but we have recognized that claims premised upon systemic 

shortcomings of medical-care providers may be cognizable under the Eighth Amendment. See 

North v. Cuyahoga County, 754 F. App’x 380, 392 (6th Cir. 2018). Yet we do not know what a 

successful claim would look like here. Although Martin’s weak summary-judgment showing still 

makes clear that the contractual structure or arrangement between SHP and the WCRJ raises 

concerns regarding the administration of the jail medical program, her briefing does not come close 

to identifying widespread failure that SHP knew or should have known about or how these failures 

caused Burke to skip his dose of prednisone. The brief does not refer to or provide evidence of 

other similar incidents. Accordingly, Martin fails to demonstrate an issue of material fact on this 

record for her claims against SHP.

IV. CONCLUSION

For the reasons set forth above, we AFFIRM the judgment of the district court.

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