Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_10-cv-02031/USCOURTS-azd-2_10-cv-02031-0/pdf.json

Nature of Suit Code: 440
Nature of Suit: Other Civil Rights
Cause of Action: 42:1983 Civil Rights Act

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IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

Anna Madrid, 

Plaintiff, 

vs.

Maricopa County, et al., 

Defendants. 

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No. CV-10-2031-PHX-GMS

ORDER

Pending before the Court is an Amended Motion to Dismiss (Doc. 5) filed by

Defendants Maricopa County, Maricopa County Correctional Health Services (“CHS”),

Maricopa County Sheriff’s Office (“MCSO”), and several individual health care

professionals. For the following reasons, the Court grants in part and denies in part the

Motion. 

BACKGROUND

Plaintiff’s claims arise from her experience as a pre-trial detainee in the Maricopa

County Jail system from May 12 to May 28, 2009. Before Plaintiff entered custody, she had

sustained a “severe right wrist laceration which injured all vital structures within her forearm.”

(Doc. 1-1, ¶14). On April 24, 2009, Dr. Steven Bastian (“Bastian”) performed surgery on

Plaintiff’s forearm. (Id. at ¶ 15). Thereafter, Bastian required Plaintiff “to wear an ‘extension

block splint’” to ensure she healed correctly. (Id.). On May 12, 2009, Plaintiff “was arrested

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and taken to the 4th Avenue Jail Intake” and subsequently “transferred to Estrella Jail where

she was taken to the medical center.” (Id. at ¶ 17). Plaintiff was seen by the individual

Medical Defendants – nurses M. Lugo, M. Kotapke, and Myriam Diaz, physician assistant

D. Bunkers, and Dr. M. Gaskins – on May 12 and May 14. (Id.).

Plaintiff filed a Complaint, raising a cause of action pursuant to 42 U.S.C. § 1983

based on a violation of her Fourteenth Amendment rights as a result of Defendants’

deliberate indifference to her medical needs. Within this claim, Plaintiff alleges that

Defendant Maricopa County failed to properly train and/or supervise the individual Medical

Defendants. Plaintiff also alleges a number of state law claims, including negligence, gross

negligence, medical malpractice, and failure to provide medical care under state law.

After removing to this Court, Defendants moved to dismiss Plaintiff’s claims on the

following grounds: CHS and MCSO are non-jural entities incapable of being sued; Maricopa

County and CHS cannot be sued for medical negligence; Maricopa County is not liable for

punitive damages; Plaintiff has failed to state a § 1983 claim for denial of constitutionally

adequate medical care; Plaintiff’s claims allege medical negligence, which falls short of the

constitutional requirement of deliberate indifference; the Sheriff, rather than Maricopa

County, is responsible for the conditions of confinement within the Maricopa County Jails;

Plaintiff has failed to state a § 1983 claim for failure to train personnel; and Maricopa County

cannot be held vicariously liable for the conduct of others.

DISCUSSION

I. Legal Standard

To survive dismissal for failure to state a claim pursuant to Federal Rule of Civil

Procedure 12(b)(6), a complaint must contain more than “labels and conclusions” or a

“formulaic recitation of the elements of a cause of action”; it must contain factual allegations

sufficient to “raise a right to relief above the speculative level.” Bell Atl. Corp. v. Twombly,

550 U.S. 544, 555 (2007). While “a complaint need not contain detailed factual allegations

. . . it must plead ‘enough facts to state a claim to relief that is plausible on its face.’”

Clemens v. DaimlerChrysler Corp., 534 F.3d 1017, 1022 (9th Cir. 2008) (quoting Twombly,

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1

 Because Plaintiff concedes that this is not a conditions of confinement case, (Doc.

10 at 15), the Court disregards Defendants’ arguments to the contrary. 

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550 U.S. at 570). The plausibility standard “asks for more than a sheer possibility that a

defendant has acted unlawfully. Where a complaint pleads facts that are merely consistent

with a defendant’s liability, it stops short of the line between possibility and plausibility of

entitlement to relief.” Id. (quoting Twombly, 550 U.S. at 555) (internal citations and

quotation marks omitted). 

When analyzing a complaint for failure to state a claim under Rule 12(b)(6), “[a]ll

allegations of material fact are taken as true and construed in the light most favorable to the

nonmoving party.” Smith v. Jackson, 84 F.3d 1213, 1217 (9th Cir. 1996). However, legal

conclusions couched as factual allegations are not given a presumption of truthfulness, and

“conclusory allegations of law and unwarranted inferences are not sufficient to defeat a

motion to dismiss.” Pareto v. FDIC, 139 F.3d 696, 699 (9th Cir. 1998). 

II. Defendants’ Motion to Dismiss

A. Liability of CHS and MCSO

Defendants argue that CHS and MCSO are non-jural entities that cannot be sued.

Plaintiff concedes that this is the case. (Doc. 10). Because Plaintiff agrees that CHS and

MCSO are non-jural entities, and this Court’s prior rulings support this assertion, Payne v.

Arpaio, 2009 WL 3756679, at *4–5 (D. Ariz. Nov. 24, 2009); see also Braillard v. Maricopa

Cnty., 224 Ariz. 481, 487, 232 P.3d 1263, 1269 (App. 2010), the Court will dismiss these

Defendants. 

B. Count 1: 42 U.S.C. § 1983

Plaintiff alleges that Defendants “engaged in conduct that was the proximate cause

of a violation of Plaintiff’s rights under [the] Fourteenth Amendment . . . to the Constitution

of the United States of America, including but not limited to his [sic] right to be provided

adequate medical treatment and adequate conditions of confinement,” which violates

“Plaintiff’s civil rights under 42 U.S.C. § 1983.” (Doc. 1-1, ¶ 30).1

 

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2

 In their Reply, Defendants further contend that “Plaintiff has not made any factual

allegations whatsoever against M. Lugo, LPN, M. Kotapke, RN or D. Bunkers, PA-C,” so

“these defendants must, therefore, be dismissed.” (Doc. 13). The Court need not address this

issue because Defendants raise it for the first time in their Reply. See Bazuaye v. I.N.S., 79

F.3d 118, 120 (9th Cir. 1996) (“Issues raised for the first time in the reply brief are waived.”).

3

 “Claims by pretrial detainees are analyzed under the Fourteenth Amendment Due

Process Clause, rather than under the Eighth Amendment.” Frost v. Agnos, 152 F.3d 1124,

1128 (9th Cir. 1998).

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Defendants argue that Plaintiff’s claims amount to nothing more than claims of

medical negligence, which do not constitute constitutional violations. (Doc. 5).2

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to Plaintiff, though, the actions of the individual Medical Defendants fell so far below the

applicable standard of care that she was denied the treatment necessary for proper recovery.

See Doc. 1-1, ¶ 40. Specifically, Plaintiff alleges that “[w]hile the Medical Staff cared for the

wound generated by surgery, they did nothing to assure her hand healed correctly and that

she did not lose motion in her hand and fingers.” (Id. at ¶ 27). 

Under 42 U.S.C. § 1983, to maintain a Fourteenth Amendment claim based on prison

medical treatment, an inmate must show “deliberate indifference to serious medical needs.”

Jett v. Penner, 439 F.3d 1091, 1096 (9th Cir. 2006) (citing Estelle v. Gamble, 429 U.S. 97,

104 (1976)).3

 A violation of the right to adequate medical care requires alleging “that the

officials acted with deliberate indifference in failing to respond to a serious medical need.”

Frost v. Agnos, 152 F.3d 1124, 1130 (9th Cir. 1998). In other words, a plaintiff must show

(1) a serious medical need and (2) that the defendant’s response was deliberately indifferent.

Jett, 439 F.3d at 1096. The Court concludes that Plaintiff has stated a claim for denial of

medical care and deliberate indifference in violation of the Due Process Clause of the

Fourteenth Amendment. Accordingly, Plaintiff has stated a claim under § 1983.

(i) Serious Medical Need

To demonstrate a serious medical need, the plaintiff must show that “the failure to

treat [the plaintiff’s] condition could result in further significant injury or the unnecessary

and wanton infliction of pain.” McGuckin v. Smith, 974 F.2d 1050, 1059 (9th Cir. 1991),

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overruled on other grounds by WMX Techs., Inc. v. Miller, 104 F.3d 1133 (9th Cir. 1997) (en

banc) (quoting Estelle v. Gamble, 429 U.S. 97, 104 (1976)) (internal quotation marks

omitted). Examples of serious medical needs include the existence of an injury that a

reasonable doctor or patient would find important and worthy of comment or treatment, the

presence of a medical condition that significantly affects an individual’s daily activities, or

the existence of chronic and substantial pain. Id. at 1059–60. 

Prior to entering into custody, Plaintiff had sustained “a severe right wrist laceration

which injured all vital structures in her forearm.” (Doc 1-1 at ¶ 14). After surgery, Plaintiff

wore an “‘extension block splint’ to assure that her fingers and wrist did not contract and

would heal correctly.” (Id. at ¶ 15). The Court recognizes that such a severe wrist injury is

something a reasonable doctor would find worthy of comment, and which could result in

further significant injury to Plaintiff. In fact, after being released from custody and seeing her

surgeon on June 11, 2009, the surgeon found that Plaintiff’s fingers were “positioned in a

‘flexed posture,’ unable to be extended at the MP joints” and that Plaintiff displayed “little

of [sic] any active flexion of her digits or her thumb.” (Id. at ¶¶ 24–25). Accordingly,

Plaintiff has pled sufficient facts to demonstrate a serious medical need.

(ii) Deliberate Indifference

A plaintiff can satisfy the deliberate indifference requirement by showing (a) a

purposeful act or failure to respond and (b) harm caused by this indifference. Jett, 439 F.3d

at 1096. In other words, deliberate indifference “may appear when prison officials deny,

delay, or intentionally interfere with medical treatment, or it may be shown by the way in

which prison physicians provide medical care.” Hutchinson v. United States, 838 F.2d 390,

394 (9th Cir. 1988) (citing Estelle, 429 U.S. at 104–05). The indifference to medical needs,

however, “must be substantial; a constitutional violation is not established by negligence or

‘an inadvertent failure to provide adequate medical care.’” Anderson v. Cnty. of Kern, 45

F.3d 1310, 1316 (quoting Estelle, 429 U.S. at 105–06). In describing the state of mind

necessary for “deliberate indifference,” the Supreme Court has held that a prison official

must disregard “a risk of harm of which he is aware.” Farmer v. Brennan, 511 U.S. 825, 837

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(1994).

Plaintiff’s Amended Complaint alleges that Defendants “failed to provide Plaintiff

with appropriate medical care and treatment.” (Doc. 1-1, ¶ 39). Even though the medical staff

at the jail possessed Plaintiff’s “records regarding her surgery and treatment,” (Id. at ¶ 18),

which conveyed Dr. Bastian’s orders for Plaintiff to wear an “extension block splint” and to

have physical therapy, (Id. at ¶¶ 15–16), Dr. Gaskins “ordered wound care for the staples”

but “did not order physical therapy.” (Id. at ¶ 19). Additionally, “on May 25, 2009, the splint

was removed and thrown away by Nurse Myriam Diaz and replaced with elastic netting.” (Id.

at ¶ 21). This then deprived Plaintiff of “the splint medically prescribed to keep flexion and

stop contraction in her hand and fingers.” (Id. at ¶ 22).

Based on the foregoing facts, Plaintiff has adequately stated a claim for deliberate

indifference to a serious medical need pursuant to § 1983. The Amended Complaint

demonstrates that the named healthcare professionals, even though they possessed Plaintiff’s

records from her surgery, did not provide the medical care that the records would have

indicated was necessary. 

C. Maricopa County’s Liability with Respect to Plaintiff’s § 1983 Claim

Defendants assert that, in Arizona, the responsibility for operating jails and caring for

prisoners is placed by law upon the sheriff, see A.R.S. §§ 11-441(A)(5), 31-101, who is a

county officer, Ariz. Const. art. 12, §§ 3, 4. (Doc. 5). They assert that Maricopa County is

not responsible for the operation of the jails. See A.R.S. § 11-251. Defendants argue that all

of Plaintiff’s allegations against the County regarding the operation of the jail, the jail’s

policies and procedures, and employees of the jail, fail to state a claim against Maricopa

County and must be dismissed. (Doc. 5). However, Plaintiff asserts (Doc. 10) and Defendants

concede (Doc. 13) that Maricopa County is responsible for medical care in the jails.

Maricopa County, though, asserts that it cannot be held vicariously liable because

Monell v. Department of Social Services of the City of New York stated that “a municipality

cannot be held liable under § 1983 on a respondeat superior theory” and thus municipalities

can only be held liable if the “action[,] pursuant to [an] official municipal policy of some

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nature[,] caused a constitutional tort.” (Doc. 5) (citing Monell v. N.Y. City Dep’t of Soc.

Servs., 436 U.S. 658, 691 (1978)). The County contends that there are “no constitutionally

insufficient policies or procedures” involved to state a Monell claim. (Doc. 13).

“[A] municipality can be found liable under [section] 1983 only where the

municipality itself causes the constitutional violation at issue. Respondeat superior or

vicarious liability will not attach under [section] 1983.” City of Canton v. Harris, 489 U.S.

378, 385 (1989) (citing Monell, 436 U.S. at 694–95) (emphasis omitted)). However,

municipalities can also be held liable for deprivations of constitutional rights resulting from

their policies or customs, Monell, 463 U.S. at 690–91, and by showing that the alleged

constitutional violation was caused by a failure to adequately train municipal employees.

Canton, 489 U.S. at 388–91. To successfully assert a municipality’s liability under this

theory, “a plaintiff must show that the municipality’s deliberate indifference led to its

omission and that the omission caused the employee to commit the constitutional violation.”

Gibson v. Cnty. of Washoe, Nev., 290 F.3d 1175, 1186 (9th Cir. 2002) (citing Canton, 489

U.S. at 387). The Ninth Circuit has held that plaintiffs need not specifically allege a custom

or policy; it is enough if the custom or policy can be inferred from the allegations of the

complaint. Shaw v. State of Cal. Dep’t of Alcoholic Beverage Control, 788 F.2d 600, 610 (9th

Cir. 1986).

Plaintiff’s Complaint asserts that “Defendants have a history of and/or maintain a

custom, policy, practice and/or procedure of deliberate indifference to medical care and

treatment of inmates who arrive at the jail with a preexisting medical condition.” (Doc. 1-1,

¶ 32). Furthermore, Plaintiff posits that Maricopa County failed to adequately train its

employees, which led to the constitutional violation. (Id. at ¶ 33). The Amended Complaint

alleges that “Defendant Maricopa County . . . failed to have on staff competent and fully

trained medical personal [sic] who were trained to evaluate the arm injury and trained to

provide immediate and/or emergency medical care and treatment to Plaintiff’s wrist.” (Doc.

1-1). As training regarding the health needs of prisoners is inherent in creating a wellfunctioning correctional facility, the Amended Complaint fairly alleges that the County was

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deliberately indifferent to Plaintiff’s medical needs. See, e.g., Lee v. Arizona, 2010 WL

3941857, at *5 (D. Ariz. Oct. 6, 2010). Therefore, the Court finds that Plaintiff has

adequately stated a Monell claim against Maricopa County for liability pursuant to § 1983.

D. Count 2: State Tort Claims

In her Complaint, Plaintiff alleges that Defendant Maricopa County “(1) failed to

provide Plaintiff with appropriate medical care and treatment; (2) failed to have in place

policies, procedures and/or staff whereby Plaintiff, as an inmate, could receive prompt,

accurate and professional evaluation of medical condition [sic] and quick, prompt and

professional medical care and treatment; and/or (3) failed to have on staff competent and

fully trained medical personal [sic] who were trained to evaluate the arm injury and trained

to provide immediate and/or emergency medical care and treatment to Plaintiff’s wrist.”

(Doc. 1-1, ¶ 39). Additionally, Plaintiff asserts that “Defendants owed Plaintiff a duty to

provide her with competent medical care and treatment,” but “[t]he actions of the Medical

Defendants fell below and violate[d] completely the standard of care.” (Id. at ¶ 40).

Moreover, Plaintiff asserts that under the theory of respondeat superior, Defendant Maricopa

County is liable for the “negligent/grossly negligent acts of its employees that occurred in

the course and scope of employment”. (Id. at ¶ 7).

(i) Medical Malpractice 

Arizona defines medical malpractice as “an action for injury or death against a

licensed health care provider.” A.R.S. § 12-561(2). A “[l]icensed health care provider” is

defined as “[a] person, corporation, or institution licensed or certified by the state to provide

health care, medical services, nursing services, or other health-related services.” Id. at. §

12-561(1). An Arizona court interpreted the statute by stating: “[w]hile A.R.S. § 12-561 does

not explain licensed, it is in accord with the overall statutory scheme that the license referred

to is a license from DHS [the State Department of Health Services]—the department created

for the sole purpose of controlling licensing standards for health care institutions.” Sahf v.

Lake Havasu City Ass’n for the Retarded and Handicapped, 150 Ariz. 50, 58, 721 P.2d 1177,

1195 (App. 1986) (internal quotation marks omitted). 

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Maricopa County is not a licensed healthcare provider. A.R.S. § 36-402(A)(11)

requires Maricopa County’s medical facilities at the jail be accredited by either the national

corrections commission on health care or an American correctional association. Thus,

Maricopa County’s jail medical facilities are not licensed or certified by the State.

Additionally, A.R.S. 36-402(A)(11) provides that “[t]his chapter [Public Health and Safety]

. . . do[es] not authorize the licensure, supervision, regulation or control of . . . [a] facility that

provides medical and health services to inmates who are confined in a county jail.”

Accordingly, because the County is not licensed by DHS, it is not a licensed health care

provider and may not be sued under a medical malpractice cause of action.

Although Maricopa County cannot be sued directly for medical malpractice, the

County can be held vicariously liable for the alleged malpractice of its employees, the

individual Medical Defendants.

(ii) Negligence

The Court concludes that Plaintiff states a claim based on negligence principles

against the individual Medical Defendants. The Court also concludes that Maricopa County

can be held vicariously liable for the negligence claims. Plaintiff cites to Ryan v. State, 134

Ariz. 308, 656 P.2d 597 (1982) and Hutcherson v. City of Phoenix, 188 Ariz. 183, 933 P.2d

1251 (App. 1997), overruled on other grounds by Hutcherson v. City of Phoenix, 192 Ariz.

51, 971 P.2d 449 (1998), to support her contention that Maricopa County can be held

vicariously liable for the negligence of its employees who are medical professionals.

Although Defendants attempt to distinguish Ryan in their Reply, the Court finds the two

cases persuasive.

In Hutcherson, the city was held vicariously liable for the negligence of its employee,

a 911 operator. 188 Ariz. at 187, 933 P.2d at 1255. The Court relied upon Ryan in holding

that the city should be held liable based on a theory of respondeat superior. For example, the

Court stated that “Ryan found that the legislature has ‘recognized that the state is liable for

the negligent acts of its agents.’” Id. at 189, 933 P.2d at 1257 (quoting Ryan, 134 Ariz. at

310, 656 P.2d at 599). Furthermore, the Court stated: “Ryan declared that, generally, the state

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and its agents will be subject to the same tort law as private citizens,” which is usually a

negligence standard of care. Id. (quoting Ryan, 134 Ariz. at 311, 656 P.2d at 600) (internal

quotation marks omitted). 

To bolster the conclusion that courts may find government entities liable for the

negligent actions of their employees, the Court points to Simmons v. U.S., 805 F.2d 1363 (9th

Cir. 1986). There, the Ninth Circuit found the United States liable, based on the theory of

respondeat superior, for a counselor’s negligence “in his capacity as a social worker

employed by a United States agency.” Id. at 1364, 1371. The United States was liable

because it employed the counselor and because the counselor was acting within the scope of

his employment. Id. at 1371. Thus, the Court finds that Maricopa County can similarly be

held vicariously liable for the negligent actions of its employees. 

E. Punitive Damages

Defendants argue that a claim for punitive damages against Maricopa County must

be dismissed because § 1983 does not authorize damages against local governmental entities.

(Doc. 5). Punitive damages are not recoverable against a municipality or a state official sued

in his or her official capacity, but are recoverable against state officials sued in their

individual capacities. See City of Newport v. Fact Concerts, Inc., 453 U.S. 247, 271 (1981).

The same holds true under state law for public employees acting within the scope of their

employment. See A.R.S. § 12-820.04. Accordingly, the Court grants Defendants’ Motion

with respect to Plaintiff’s punitive damages claim against Maricopa County and the

individual Medical Defendants in their official, but not individual, capacities. 

CONCLUSION

The Court dismisses MCSO and CHS as defendants because they are non-jural

entities. The Court denies Defendants’ Motion with respect to Plaintiff’s § 1983 claims

against the Medical Defendants and Maricopa County. Additionally, Plaintiff states a claim

for medical malpractice and negligence with respect to the individual Medical Defendants.

However, because Maricopa County is not a licensed health care provider, it cannot be sued

for medical malpractice. Maricopa County can, however, be held vicariously liable for the

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negligent actions and medical malpractice of its employees. Finally, Plaintiff’s claim for

punitive damages is dismissed against the County and the individual Medical Defendants in

their official capacities.

IT IS THEREFORE ORDERED that Defendants’ Amended Motion to Dismiss

(Doc. 5) is GRANTED in part and DENIED in part. 

DATED this 26th day of April, 2011. 

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