IN THE UNITED STATES COURT OF APPEALS

FOR THE FIFTH CIRCUIT

No. 14-10126

ESTATE OF WILBERT LEE HENSON, deceased; BARBARA KAY HENSON 

REED, Individually and on behalf of Estate of Wilbert Lee Henson; IWILLER 

G HENSON HENDRIX; WILMA LYNN HENSON; SHELISHA 

RICHARDSON, 

 Plaintiffs - Appellants

v.

WICHITA COUNTY, TEXAS; DOCTOR DANIEL BOLIN, 

 Defendants - Appellees

Appeal from the United States District Court

for the Northern District of Texas

Before BARKSDALE, SOUTHWICK, and HIGGINSON, Circuit Judges.

STEPHEN A. HIGGINSON, Circuit Judge:

This 42 U.S.C. § 1983 case arises out of the death of Wilbert Lee Henson 

while in pretrial detention in a jail in Wichita County, Texas. This is the third 

appeal in this case. In the prior appeals, this court held that Defendants Nurse 

Kaye Krajca and Sheriff Thomas J. Callahan were entitled to qualified 

immunity. See Estate of Henson v. Krajca, 440 F. App’x 341 (5th Cir. 2011); 

Estate of Henson v. Callahan, 440 F. App’x 352 (5th Cir. 2011). Subsequently, 

relying heavily on this court’s decisions, the district court granted summary 

United States Court of Appeals

Fifth Circuit

FILED

July 28, 2015

Lyle W. Cayce

Clerk

 Case: 14-10126 Document: 00513132667 Page: 1 Date Filed: 07/28/2015
No. 14-10126

2

judgment in favor of the remaining two Defendants, Wichita County and Dr. 

Daniel Bolin. Plaintiffs timely appealed that decision, which we now AFFIRM.

FACTUAL AND PROCEDURAL BACKGROUND

On November 23, 2004, Henson was arrested for an outstanding warrant 

of bond forfeiture for driving with a suspended license and was taken to the 

Wichita County jail. Upon arrival, he informed the detention officer that he 

had pneumonia and emphysema and had been in the ER a few days earlier. 

The detention officer called the nurse on duty, Nurse George, and informed her 

that Henson was having trouble breathing.1 When Nurse George saw Henson, 

he was “yelling and screaming” that he was short of breath. Nurse George 

gave Henson an albuterol inhaler and Keflex (an antibiotic), filled out an 

“Inmate Request for Medical Attention” (a “pink card”), and put him on the list

to see Dr. Bolin, the physician in charge of the jail, the next morning. 

Overnight, however, Henson was transferred from the downtown facility to the 

jail annex, so he was not seen by Dr. Bolin during sick call on November 24. 

While Dr. Bolin usually held sick call at the annex the next day, he did not 

hold one on November 25 because it was Thanksgiving.

While at the annex, Henson’s health declined. Henson, joined by other 

inmates in his cell block who recognized that he was sick, asked the officers to 

provide him medical care. On November 26, after Henson informed one of the 

detention officers that he had been using his inhaler every 10 minutes with no 

relief, the officer contacted Nurse Krajca. Nurse Krajca saw Henson and filled 

out a pink card, which noted that Henson was complaining of COPD (chronic 

obstructive pulmonary disorder) and pneumonia. Nurse Krajca gave him 

 

1 All of the nurses that interacted with Henson were “licensed vocational nurses” 

(“LVNs”). The Texas Nurse Practice Act states that “[t]he licensed vocational nurse practice 

is a directed scope of nursing practice under the supervision of a registered nurse, advanced 

practice registered nurse, physician’s assistant, physician, podiatrist, or dentist.” 22 Tex. 

Admin. Code § 217.11(2). 

 Case: 14-10126 Document: 00513132667 Page: 2 Date Filed: 07/28/2015
No. 14-10126

3

albuterol, put him on the list to see Dr. Bolin at the next sick call, and left 

instructions to the officers that Henson “may have one [breathing] treatment 

every 4 hrs if needed.”

The last medical professional to see Henson was Nurse Coleman, who 

visited the general population tank on November 27 and spoke with Henson 

through the bars. Nurse Coleman gave him a seven-day supply of an antibiotic, 

an albuterol inhaler, and cough drops. Later that night, shortly after being 

taken for a breathing treatment, Henson pressed the intercom button to alert 

the control room that he was still having problems breathing. The shift 

supervisor called Nurse George, who instructed him to put Henson in solitary 

confinement, or “medical solitary,” and check on him every fifteen minutes. 

The shift supervisor called Nurse Krajca for a second opinion, who told him to 

put Henson in medical solitary, take his vital signs, and check on him every 

thirty minutes. One of the detention officers took Henson’s vital signs and 

reported them to Nurse Krajca: Blood Pressure 208/107, Pulse 92. 

Early in the morning of November 29, so a day later, Henson pushed an 

emergency button located in his cell. The detention officers found him in his 

cell gasping for air, saying “I’m not going to make it.” The officers put him in 

a wheelchair and took him to the multipurpose room, where they tried to give 

him a breathing treatment and calm him down. After a few minutes of 

struggling, Henson’s eyes rolled back in his head and he passed out. The 

officers tried to perform CPR on Henson and called an ambulance. Henson was 

taken to the hospital where he was pronounced dead at approximately 6:17 

a.m. on November 29. 

Henson’s four daughters filed the present lawsuit against numerous 

Defendants, including Wichita County, Sheriff Callahan, Dr. Bolin, and Nurse 

 Case: 14-10126 Document: 00513132667 Page: 3 Date Filed: 07/28/2015
No. 14-10126

4

Krajca.2 Relevant to this appeal, Plaintiffs contend that they are entitled to 

damages pursuant to § 1983 because Defendants, acting under the color of 

state law, violated Henson’s Fourteenth Amendment rights by denying him 

medical care. Each of these Defendants filed a motion for summary judgment. 

The district court denied summary judgment to the County and denied 

summary judgment to the individual Defendants, concluding that they were 

not entitled to qualified immunity. Nurse Krajca and Sheriff Callahan 

appealed, and this court reversed.3 See Krajca, 440 F. App’x at 347; Callahan, 

440 F. App’x at 358. This court concluded that Nurse Krajca was entitled to 

qualified immunity because there was no evidence that she was deliberately 

indifferent to Henson’s medical condition and medical needs. Krajca, 440 F. 

App’x at 346. Relatedly, the court held that because there was “no predicate 

constitutional violation upon which to base Sherriff Callahan’s supervisory 

liability,” he was also entitled to qualified immunity. Callahan, 440 F. App’x 

at 358. 

Although this court did not explicitly address Dr. Bolin’s or Wichita 

County’s potential liability, both Defendants asked the district court to 

reconsider its previous orders denying their motions for summary judgment,

in light of this court’s decisions. The parties consented to proceed before a 

magistrate judge who, relying heavily on Krajca and Callahan, granted the 

motions to reconsider and granted summary judgment, dismissing the 

Plaintiffs’ remaining claims. Plaintiffs timely appealed.

 

2 Plaintiffs named other Defendants, including detention officers and nurses, but none 

remain before this court. 

3 Dr. Bolin also appealed the district court’s denial of summary judgment, but his 

appeal was dismissed for failure to prosecute. 

 Case: 14-10126 Document: 00513132667 Page: 4 Date Filed: 07/28/2015
No. 14-10126

5

DISCUSSION

I. Standard of Review & Applicable Law

This court reviews “a district court’s summary judgment ruling de novo, 

applying the same standard as the district court.” Stanley v. Trinchard, 500 

F.3d 411, 418 (5th Cir. 2007). “The court shall grant summary judgment if the 

movant shows 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). “[T]he 

court must view the evidence in the light most favorable to the party resisting 

the motion,” here, the Plaintiffs. Trevino v. Celanese Corp., 701 F.2d 397, 407 

(5th Cir. 1983).

Dr. Bolin asserts, and the district court agreed, that he is entitled to 

qualified immunity, which alters the usual summary judgment burden of proof 

with respect to Plaintiffs’ claims against him. See Brown v. Callahan, 623 F.3d 

249, 253 (5th Cir. 2010). “Once an official pleads the defense [of qualified 

immunity], the burden then shifts to the plaintiff, who must rebut the defense 

by establishing a genuine fact issue as to whether the official’s allegedly 

wrongful conduct violated clearly established law.” Id. Confronted with a 

claim of qualified immunity, this court must determine whether the Plaintiffs 

allege the deprivation of a constitutional right and whether that right was 

clearly established at the time of the violation. See Wilson v. Layne, 526 U.S. 

603, 609 (1999). “The Court may conduct the two-pronged inquiry in any 

order.” Crostley v. Lamar Cnty., Tex., 717 F.3d 410, 422 (5th Cir. 2013). 

The constitutional rights of a pretrial detainee are found in the 

procedural and substantive due process guarantees of the Fourteenth 

Amendment. Hare v. City of Corinth, Miss., 74 F.3d 633, 639 (5th Cir. 1996)

(en banc); see also Krajca, 440 F. App’x at 343 (“The Fourteenth Amendment 

requires that state officials not disregard the ‘basic human needs’ of pretrial 

detainees, including medical care.”). This is because, 

 Case: 14-10126 Document: 00513132667 Page: 5 Date Filed: 07/28/2015
No. 14-10126

6

when the State by the affirmative exercise of its power 

so restrains an individual’s liberty that it renders him 

unable to care for himself, and at the same time fails 

to provide for his basic human needs—e.g., food, 

clothing, shelter, medical care, and reasonable 

safety—it transgresses the substantive limits on state 

action set by the Eighth Amendment and the Due 

Process Clause. 

DeShaney v. Winnebago Cnty. Dep’t of Soc. Servs., 489 U.S. 189, 200 (1989).

Though the state has a recognized interest in detaining defendants for trial, 

the substantive limits on state action set by the Due Process Clause provide 

that the state cannot punish a pretrial detainee. Bell v. Wolfish, 441 U.S. 520, 

535 (1979). In this circuit, the legal standard used to measure the due process 

rights of pretrial detainees depends on whether the detainee challenges the 

constitutionality of a condition of his confinement or whether he challenges an 

episodic act or omission of an individual state official. Hare, 74 F.3d at 644-

45. 

II. Episodic Acts vs. Conditions of Confinement

The parties dispute whether Plaintiffs challenge a condition of Henson’s 

confinement or an episodic act or omission by one or more state officials. This

distinction was developed by our en banc court in Hare v. City of Corinth, 

Mississippi, 74 F.3d at 644-45. See also Nerren v. Livingston Police Dept., 86 

F.3d 469, 473 n.25 (5th Cir. 1996) (describing Hare as “a single opinion that 

clearly and concisely articulates and unifies our court’s case law in this area”).

In this circuit, post-Hare, “[c]onstitutional challenges by pretrial detainees 

may be brought under two alternative theories: as an attack on a ‘condition of 

confinement’ or as an ‘episodic act or omission.’” Shepherd v. Dallas Cnty., 591 

F.3d 445, 452 (5th Cir. 2009) (citing Hare, 74 F.3d at 644-45). 

A challenge to a condition of confinement is a challenge to “general 

conditions, practices, rules, or restrictions of pretrial confinement.” Hare, 74 

 Case: 14-10126 Document: 00513132667 Page: 6 Date Filed: 07/28/2015
No. 14-10126

7

F.3d at 644. These conditions, practices, rules, and restrictions can be explicit, 

such as “the number of bunks per cell, mail privileges, disciplinary segregation, 

etc.” Shepherd, 591 F.3d at 452. Or, “[i]n some cases, a condition may reflect 

an unstated or de facto policy, as evidenced by a pattern of acts or omissions 

‘sufficiently extended or pervasive, or otherwise typical of extended or 

pervasive misconduct by [jail] officials, to prove an intended condition or 

practice.’” Id. (alteration in original) (quoting Hare, 74 F.3d at 645). When a 

plaintiff is challenging a condition of confinement, this court applies the test 

established by the Supreme Court in Bell v. Wolfish, and asks whether the 

condition is “reasonably related to a legitimate governmental objective.” See 

Hare, 74 F.3d at 646; Bell, 441 U.S. at 539. “[I]f a restriction or condition is 

not reasonably related to a legitimate goal—if it is arbitrary or purposeless—

a court permissibly may infer that the purpose of the governmental action is 

punishment that may not constitutionally be inflicted upon detainees qua 

detainees.” Bell, 441 U.S. at 539. Because “[a] State’s imposition of a rule or 

restriction during pretrial confinement manifests an avowed intent to subject 

a pretrial detainee to that rule or restriction,” the plaintiff need not 

demonstrate that the state actor or municipal entity acted with intent to 

punish. Hare, 74 F.3d at 644. “[A] true jail condition case starts with the 

assumption that the State intended to cause the pretrial detainee’s alleged 

constitutional deprivation.” Id. at 644-45. 

For example, in Shepherd v. Dallas County, a former pretrial detainee 

sued Dallas County after he suffered a stroke in the Dallas County Jail 

allegedly as a result of not receiving proper medication and medical attention. 

591 F.3d at 449. In his complaint, the plaintiff alleged that: “The jail’s 

evaluation, monitoring, and treatment of inmates with chronic illness was, at 

the time of [the plaintiff’s] stroke, grossly inadequate due to poor or nonexistent procedures and understaffing of guards and medical personnel, and 

 Case: 14-10126 Document: 00513132667 Page: 7 Date Filed: 07/28/2015
No. 14-10126

8

these deficiencies caused his injury.” Id. at 453. This court affirmed the jury’s 

verdict in favor of the plaintiff, holding that the plaintiff properly presented a 

successful conditions-of-confinement claim. Id. The court emphasized that the 

plaintiff’s claim did “not implicate the acts or omissions of individuals but the 

jail’s system of providing medical care to inmates with chronic illness.” Id. The 

court stressed that the plaintiff “relied on evidence showing that the 

inadequate treatment he received in a series of interactions with the jail’s 

medical system inevitably led to his suffering a stroke.” Id. The court noted, 

however, that because “no single individual’s error actually caused [the 

plaintiff’s] hypertensive decline into a stroke,” the district court was correct in 

granting summary judgment to the defendant on the plaintiff’s episodic-actsor-omissions claim. Id. at 453 n.2. 

An episodic-acts-or-omissions claim, by contrast, “faults specific jail 

officials for their acts or omissions.” Id. at 452; see also Scott v. Moore, 114 

F.3d 51, 53 (5th Cir. 1997) (en banc) (“[W]here the complained-of harm is a 

particular act or omission of one or more officials, the action is characterized 

properly as an ‘episodic act or omission’ case . . . .”). In such a case, an actor is

“interposed between the detainee and the municipality, such that the detainee 

complains first of a particular act of, or omission by, the actor and then points 

derivatively to a policy, custom, or rule (or lack thereof) of the municipality 

that permitted or caused the act or omission.” Scott, 114 F.3d at 53. The 

relevant question becomes “whether that official breached his constitutional 

duty to tend to the basic human needs of persons in his charge,” and 

intentionality is no longer presumed. Hare, 74 F.3d at 645. A jail official 

violates a pretrial detainee’s constitutional right to be secure in his basic 

human needs only when the official had “subjective knowledge of a substantial 

risk of serious harm” to the detainee and responded to that risk with deliberate 

indifference. Id. at 650. In other words, the state official must know of and 

 Case: 14-10126 Document: 00513132667 Page: 8 Date Filed: 07/28/2015
No. 14-10126

9

disregard an excessive risk to inmate health or safety. Krajca, 440 F. App’x at 

343. “‘[T]he official must both be aware of facts from which the inference could 

be drawn that a substantial risk of serious harm exists, and he must also draw 

the inference.’” Id. (quoting Calhoun v. Hargrove, 312 F.3d 730, 734 (5th Cir. 

2002)). 

In Scott v. Moore, the court characterized the plaintiff’s lawsuit, arising 

out of a jailer’s sexual assault of a pretrial detainee, as an episodic-acts-oromissions case. 114 F.3d at 53-54. The court rejected the plaintiff’s argument 

that the assault was directly caused by constitutionally inadequate staffing, 

and thus implicated a condition of confinement rather than an episodic act. Id.

at 53. The court explained that “the actual harm of which [the plaintiff] 

complains is the sexual assaults committed by [the jailer] during the one eighthour shift-an episodic event perpetrated by an actor interposed between [the 

plaintiff] and the city, but allegedly caused or permitted by the aforesaid 

general conditions.” Id. The court emphasized that “[the plaintiff] did not 

suffer from the mere existence of the alleged inadequate staffing, but only from 

[the jailer’s] specific sexual assaults committed on but one occasion.” Id.; see 

also Flores v. Cnty. of Hardeman, Tex., 124 F.3d 736, 738 (5th Cir. 1997) 

(applying Hare and Scott and classifying claim arising out of inmate’s suicide 

as an episodic-acts-or-omissions claim, despite allegations regarding jail’s 

training and staffing policies); Olabisiomotosho v. City of Hous., 185 F.3d 521, 

526 (5th Cir. 1999) (characterizing plaintiff’s complaint as “turn[ing] on [two 

detention officers’] alleged failure to take better care of [the plaintiff,] and [a 

third officer’s] failure to medically screen her” for asthma and explaining that 

this complaint “fits the definition of the episodic omission”). 

Significantly, there is no rule barring a plaintiff from pleading both 

alternative theories, and a court may properly evaluate each separately. See 

 Case: 14-10126 Document: 00513132667 Page: 9 Date Filed: 07/28/2015
No. 14-10126

10

Shepherd, 591 F.3d at 452 n.1. Because the Plaintiffs’ allegations against the 

two remaining Defendants differ, we will discuss each separately.

III. Dr. Bolin

Plaintiffs’ allegations against Dr. Bolin are properly characterized, and 

have been treated by both parties below, as attacking episodic acts or omissions 

rather than conditions of Henson’s confinement. In Plaintiffs’ First Amended 

Complaint, they asserted that Dr. Bolin acted with “deliberate indifference to 

Mr. Henson’s constitutional rights” through a series of omissions, such as his 

“failure to provide appropriate medical evaluation” and his “failure to 

transport Mr. Henson to an appropriate medical facility.” Plaintiffs also 

asserted that Dr. Bolin failed to provide adequate training and supervision for 

the nurses, who, as a result, failed to “exercise that degree of care that a nurse 

of ordinary prudence would have exercised under the same or similar 

circumstances on the occasion in question.” These allegations fault “specific 

jail officials for their acts or omissions,” id. at 452, rather than “conditions, 

practices, rules, or restrictions,” Hare, 74 F.3d at 644. Indeed, throughout 

Plaintiffs’ pleadings in the district court, they consistently asserted that the 

deliberate indifference standard should apply to their claims against Dr. Bolin. 

In response to Dr. Bolin’s motion for a more definite statement, Plaintiffs set 

forth detailed factual allegations regarding their claims against Dr. Bolin. In 

that response, Plaintiffs explicitly urged the court to apply the deliberate 

indifference standard, acknowledging that it is the appropriate standard for 

analyzing the constitutionality of “an episodic act or omission by a 

governmental employee.” Plaintiffs made no mention of an alternative 

conditions-of-confinement theory or standard. Similarly, in response to Dr. 

Bolin’s subsequent motion to dismiss and for summary judgment, which

focused solely and extensively on the deliberate indifference standard,

Plaintiffs still did not express disagreement with this legal standard but, 

 Case: 14-10126 Document: 00513132667 Page: 10 Date Filed: 07/28/2015
No. 14-10126

11

instead, asserted that Dr. Bolin was “deliberately indifferent” to the medical 

needs of Henson and other inmates. 

Given the Plaintiffs’ allegations before the district court, we decline their 

invitation now to construe their claims against Dr. Bolin as attacking 

conditions of Henson’s confinement. To do so would effectively allow Plaintiffs 

to amend their complaint at the appellate stage. See Shepherd, 591 F.3d at 

452 n.1 (describing a challenge to conditions of confinement as a “claim” that 

can be pled and evaluated separately from, and in addition to, an episodic-actsor-omissions claim). Accordingly, we find that as to Dr. Bolin, Plaintiffs

challenged only episodic acts and omissions by him and the nurses that he 

supervised, rather than conditions of Henson’s confinement. Because

Plaintiffs on appeal have abandoned a theory of liability against Dr. Bolin 

based on episodic acts or omissions, no viable claims are left against him. 

Even if we were to construe Plaintiffs’ allegations against Dr. Bolin as 

challenging a condition of Henson’s confinement—despite Plaintiffs’ consistent 

representation to the district court that the deliberate indifference standard,

applicable to episodic-acts-or-omissions claims, should apply—Plaintiffs’ 

claims against Dr. Bolin would fail. Plaintiffs generalized in their complaint 

that Dr. Bolin “condoned and enforced with fear and intimidation a well-known 

policy and custom among the nurses of the Wichita County Sheriff’s 

Department not to send inmates with serious medical conditions to the 

hospital.” And on appeal, Plaintiffs allege that “Dr. Bolin fostered an 

environment of intimidation at the Jail, such that the LVNs (and other Jail 

staff) were so discouraged from contacting him regarding severely ill 

inmates . . . that the LVNs ultimately decided on a treatment plan for inmates.” 

As there was no explicit policy of nurse intimidation, Plaintiffs would have to 

show that an unstated or de facto policy existed. See Shepherd, 591 F.3d at 

452 (“In some cases, a condition may reflect an unstated or de facto policy . . . 

 Case: 14-10126 Document: 00513132667 Page: 11 Date Filed: 07/28/2015
No. 14-10126

12

.”). However, in order to base a constitutional claim on Dr. Bolin’s 

implementation of an unstated rule or policy, Plaintiffs must show that Dr. 

Bolin’s “acts or omissions were sufficiently extended or pervasive, or otherwise 

typical of extended or pervasive misconduct by other officials, to prove an 

intended condition or practice.” Hare, 74 F.3d at 645. Plaintiffs have not done 

so.

Plaintiffs’ evidence of a de facto “policy” of nurse intimidation comes 

mostly from a previous case involving the death of Jason Brown, a pretrial 

detainee who died in the Wichita County jail four months before Henson. 

Plaintiffs presented: (1) deposition testimony of Sheriff Callahan, taken in the 

Brown case, stating that Dr. Bolin is “grumpy” and “[d]oesn’t like to be 

bothered”; (2) an affidavit of Pathena Dawn Tweed, a former nurse at the 

Wichita County jail, who stated that she was “personally chastised by Dr. Bolin 

when [she] would contact him to obtain medical instruction” and that on one 

occasion she defied Dr. Bolin’s orders by sending a diabetic inmate to the 

hospital and Dr. Bolin “became very irate [and] yelled at [her]”; (3) an affidavit 

of Dawn Marie Wilkinson, a former nurse at the Wichita County jail, who 

similarly stated that she “feared calling Dr. Bolin for fear of unwarranted 

criticism” and that on one occasion she sent a female inmate to the hospital 

despite Dr. Bolin’s explicit instruction not to do so; and (4) a memorandum 

written by a Wichita County detention officer pertaining to Brown’s death, 

which quoted Nurse Krajca as saying: “Do you know what kind of ass chewing 

I would get from Dr. Bolin, if I sent [Jason Brown] to the hospital in the good

health that he is in.” While this evidence indicates brusque and critical 

mannerisms, it falls short of proving conduct so pervasive and typical as to 

constitute an intended condition or practice of nurse intimidation that 

discouraged nurses from sending inmates to the hospital. In fact, the two 

affidavits from former nurses support the opposite view, as they both state that 

 Case: 14-10126 Document: 00513132667 Page: 12 Date Filed: 07/28/2015
No. 14-10126

13

they sent inmates to the hospital despite Dr. Bolin’s harsh attitude. See Brown 

v. Callahan, 623 F.3d at 256 (reviewing the same affidavits and explaining 

“[t]hat two nurses decided to send inmates to the ER over Dr. Bolin’s objections 

proves the opposite of intimidation”). At most, Plaintiffs’ evidence shows that,

on one occasion, one nurse was cognizant of Dr. Bolin’s temper as she assessed 

an inmate, which is insufficient to prove an unconstitutional policy. See 

Shepherd, 591 F.3d at 454 (“[I]solated examples of illness, injury, or even 

death, standing alone, cannot prove that conditions of confinement are 

constitutionally inadequate.”). More problematic, Plaintiffs put forth no 

evidence that Dr. Bolin’s alleged intimidation of nurses played any role in the 

present case. See Duvall v. Dallas Cnty, 631 F.3d 203, 207 (5th Cir. 2011) 

(explaining that to prevail on a challenge to an unconstitutional condition of 

confinement, the plaintiff must show that the condition “caused the violation 

of [the inmate’s] constitutional rights”). Unlike in the Brown case, which 

included Nurse Krajca’s rhetorical statement about Dr. Bolin’s temper, there 

is no evidence in the present case that any of the nurses who encountered 

Henson acted, or failed to act, out of fear for Dr. Bolin. See Callahan, 440 F. 

App’x at 358 (“[N]o evidence supports that an alleged reluctance to send 

seriously ill inmates to the hospital contributed to Henson’s death.”).

Because Plaintiffs did not assert a conditions-of-confinement claim 

against Dr. Bolin, and because, even if they had, such claim would fail, we find 

that Dr. Bolin is entitled to summary judgment and the district court’s order 

is affirmed with respect to Plaintiffs’ claims against him. 

IV. Wichita County

As to Wichita County, Plaintiffs’ First Amended Complaint challenged

conditions, practices, and customs—both explicit and de facto—as well as acts 

and omissions by individual officials. For instance, Plaintiffs asserted that 

“Wichita County did not have adequate facilities, equipment, or trained staff 

 Case: 14-10126 Document: 00513132667 Page: 13 Date Filed: 07/28/2015
No. 14-10126

14

to appropriately assess and treat inmates with serious illnesses,” and that 

Wichita County “adopt[ed] a custom and practice of allowing untrained 

detention officers and nurses to unlawfully practice medicine.” Plaintiffs also 

alleged that Wichita County “adopt[ed] a custom and practice of discouraging 

detention officers and nurses from sending critically ill inmates such as Mr. 

Henson to the hospital.” Plaintiffs identified more than ten prison officials who

had contact with Henson while he was at the jail and who, according to 

Plaintiffs, did not respond properly to his medical needs. While Plaintiffs did

challenge the acts or omissions of some of those officials, they also challenged 

the jail’s multi-tiered medical system, which, according to Plaintiffs, placed

untrained, unqualified, and unsupervised staff in charge of providing medical 

care for inmates. Like the plaintiff in Shepherd, Plaintiffs here allege 

inadequate treatment “in a series of interactions with the jail’s medical 

system.” Shepherd, 591 F.3d at 453. Plaintiffs’ allegations do not focus only 

on the acts or omissions of individual officials, therefore, but also challenge the 

jail’s system of providing medical care to inmates with serious illness. See id. 

Indeed, in their filings in the district court, Plaintiffs maintained that they 

“pled both an episodic act and omissions case as well as a conditions case and 

[that they] produced evidence of both.”4

 

4 Before us, however, Plaintiffs disclaimed any theory of liability against Wichita 

County based on episodic acts or omissions of individual officials, explicitly stating during 

oral argument that this is not an episodic-acts-or-omissions case. Given the posture of this 

case, any such claim against Wichita County would fail. In order to hold a municipality liable 

for a due process violation caused by a state official’s episodic act or omission, the detainee 

must first show that there was an underlying violation by the state official. See Flores, 124 

F.3d at 739; see also Hare, 74 F.3d at 649 n.4. The detainee must show that the state official 

acted with subjective deliberate indifference, Scott, 114 F.3d at 54, and “[o]nly then may he 

hold a municipality accountable for that due process violation,” Flores, 124 F.3d at 739. 

Because none of the individual Defendants was deliberately indifferent, Plaintiffs have not 

shown an underlying constitutional violation for which Wichita County could be held liable 

on an episodic-acts-or-omissions theory. See Callahan, 440 F. App’x at 358 (“[T]hose who the 

 Case: 14-10126 Document: 00513132667 Page: 14 Date Filed: 07/28/2015
No. 14-10126

15

To assess Plaintiffs’ conditions-of-confinement claim against Wichita 

County, we apply the test established by the Supreme Court in Bell v. Wolfish. 

See Hare, 74 F.3d at 644. In Bell, the Supreme Court explained that “the 

Government . . . may detain [a pretrial detainee] to ensure his presence at trial 

and may subject him to the restrictions and conditions of the detention facility 

so long as those conditions and restrictions do not amount to punishment, or 

otherwise violate the Constitution.” 441 U.S. at 536-37. This balance 

accommodates the Government’s “substantial interest in ensuring that 

persons accused of crimes are available for trials,” while respecting a pretrial 

detainee’s constitutional “right to be free from punishment.” Id. at 534. The 

Court emphasized, crucially, that “[n]ot every disability imposed during 

pretrial detention amounts to ‘punishment’ in the constitutional sense.” Id. at 

537. Instead, as noted, the Court held that:

[I]f a particular condition or restriction of pretrial 

detention is reasonably related to a legitimate 

governmental objective, it does not, without more, 

amount to “punishment.” Conversely, if a restriction 

or condition is not reasonably related to a legitimate 

goal—if it is arbitrary or purposeless—a court 

permissibly may infer that the purpose of the 

governmental action is punishment that may not 

constitutionally be inflicted upon detainees qua

detainees. 

 

Id. at 539. The Court explained that “the effective management of the 

detention facility . . . is a valid objective that may justify imposition of 

conditions and restrictions of pretrial detention.” Id. at 540. The Court

reminded that in determining “whether restrictions or conditions are 

 

Henson family claims contributed to the death have not been shown to have committed 

constitutional violations, though they may have been negligent.”).

 Case: 14-10126 Document: 00513132667 Page: 15 Date Filed: 07/28/2015
No. 14-10126

16

reasonably related to the Government’s interest in . . . operating the institution 

in a manageable fashion,” courts must remember that “‘[s]uch considerations 

are peculiarly within the province and professional expertise of corrections 

officials.’” Id. at 540 n.23 (quoting Pell v. Procunier, 417 U.S. 817, 827 (1974)). 

Courts must not become “enmeshed in the minutiae of prison operations,”

which will only distract from the question presented: “does the practice or 

condition violate the Constitution?” Id. at 544, 562. 

With the goal of the Bell test—to identify conditions that amount to 

punishment—in mind, we turn to the conditions that Plaintiffs have 

challenged in the present case. In order to succeed on their conditions-ofconfinement claim against Wichita County, Plaintiffs need to show:

(1) “a rule or restriction or . . . the existence of an 

identifiable intended condition or practice . . . [or] that 

the jail official’s acts or omissions were sufficiently 

extended or pervasive”; (2) which was not reasonably 

related to a legitimate governmental objective; and (3) 

which caused the violation of [the inmate’s] 

constitutional rights. 

Duvall, 631 F.3d at 207 (alterations in original) (quoting Hare, 74 F.3d at 645); 

see also Edler v. Hockley Cnty. Comm’rs Court, 589 F. App’x 664, 668 (5th Cir. 

2014). Analyzing the first prong of this test is challenging here, as Plaintiffs 

do not identify one rule or practice that, standing alone, is unconstitutional. 

Instead, Plaintiffs, on appeal, allege that a combination of eight policies and 

practices, both explicit and de facto, created an “inadequate medical care 

system.”5 

 

5 Plaintiffs try to reframe certain episodic acts or omissions as jail conditions. For 

instance, they claim that “Dr. Bolin’s breach of contract” and the “arbitrary use of medical 

segregation” were part of “the Jail’s inadequate medical care system.” However, Plaintiffs 

provided no evidence that these allegedly de facto policies were pervasive or typical, or even 

that some occurred more than once. Shepherd, 591 F.3d at 452. Accordingly, we decline to 

consider the episodic acts in our conditions-of-confinement analysis.

 Case: 14-10126 Document: 00513132667 Page: 16 Date Filed: 07/28/2015
No. 14-10126

17

During the time of Henson’s death, the County had a “Health Services” 

plan (“HSP”) in effect, which indicated that the jail would employ six full-time 

nurses and one jail physician to work at the Wichita County jail facilities. The 

nurses were to “assist the [jail physician] and render day-to-day care to the 

inmates.” Dr. Bolin, who contracted with the County to provide “medical 

services to the jail inmates and juvenile detainees, at County detention 

facilities,” was only required to be present at the facilities three times per week 

for “sick call clinics.” Dr. Bolin was also required to “provide medical care for 

inmates needing emergency treatment in the emergency room” as well as “24 

hours telephone coverage.” In the event of an emergency, the nurse or 

detention officer was to send the inmate to the hospital. Dr. Bolin was 

supposed to help the jail staff and nurses establish procedures for handling 

acute and/or emergency situations. The nurses were not present at the 

facilities 24-hours per day but did receive calls during their off hours.

Plaintiffs emphasize that all of the nurses who interacted with Henson 

were LVNs, rather than registered nurses. Plaintiffs claim that the County’s 

use of LVNs was in violation of the scope of their license, as provided in the 

Texas Nurse Practice Act, which stated that “[t]he licensed vocational nurse 

practice is a directed scope of nursing practice under the supervision of a 

registered nurse, advanced practice registered nurse, physician’s assistant, 

physician, podiatrist, or dentist.” 22 Tex. Admin. Code § 217.11(2). According 

to Plaintiffs, despite the limited scope of the LVN license, no one supervised

the LVNs while they were working at the jail. Finally, Plaintiffs allege that 

“the lack of standing orders regarding pneumonia, Emphysema, and Chronic 

Obstructive Pulmonary Disorder (COPD), when combined with Dr. Bolin’s 

absence, the LVNs lack of supervision, and Dr. Bolin’s nurse intimidation, 

 Case: 14-10126 Document: 00513132667 Page: 17 Date Filed: 07/28/2015
No. 14-10126

18

forced LVNs to illegally diagnose and treat Henson.”6 Plaintiffs claim that 

these policies and customs in combination created a medical care system that 

was “woefully inadequate.” 

While the Plaintiffs have identified a combination of staffing policies and 

practices, there is nothing constitutionally deficient about the terms of the HSP 

and certainly nothing that resembles punishment. Bell, 441 U.S. at 542. 

Instead, this multi-tiered staffing arrangement has a reasonable relation to 

providing medical attention to inmates with varying levels of need. Adding the 

policy of hiring LVNs instead of registered nurses and requiring LVNs to call 

the on-call doctor, rather than providing them with standing orders to deal 

with serious medical problems, also does not make the medical system 

unconstitutional.7 In order to prove that in practice Wichita County’s medical 

system was constitutionally deficient, Plaintiffs needed to show, or at the 

summary judgment stage at least present evidence of, “more than an isolated 

incident; [they] ‘must demonstrate a pervasive pattern of serious deficiencies 

in providing for his basic human needs.’”8 Edler, 589 F. App’x at 668 (quoting 

 

6 For reasons we have already discussed, Plaintiffs failed to show that a de facto policy 

of nurse intimidation existed.

7 Plaintiffs, pointing to excerpts from Dr. Bolin’s deposition testimony, claim that no 

one was supervising the LVNs while they were working at the jail. Specifically, Dr. Bolin 

stated: “I can’t supervise [the nurses] when I’m not there” and “I am not [Nurse Krajca’s] 

supervisor. The sheriff is.” These statements, taken out of context, do little to aid our 

understanding of the relationship between Dr. Bolin and the nursing staff. Later in the 

deposition, Dr. Bolin stated “I am not their supervisor, I don’t hire and fire . . . I will supervise 

those medical occurrences that I have knowledge of and participate with. That would include 

sick call, telephone calls and any other direct contact.” Dr. Bolin also stated that his “number 

one policy . . . to all staff members, the jailers, the nurses,” was that “[i]f somebody is having 

an emergency . . . don’t call me first, call 911 and get them to the hospital for appropriate 

medical care. The next phone call you make is call me and let me know what’s going on.” 

While Dr. Bolin disclaimed responsibility for things that happened while he was not present 

at the jail, he also explained that he expected the nurses and jail staff to call him and that he 

supervised them when they did so. This testimony does not show, as Plaintiffs allege, that 

the LVNs acted with no supervision.

8 On appeal, Plaintiffs describe several other inmates who have allegedly received 

inadequate medical care in the Wichita County jail since Henson’s death. However, Plaintiffs

 Case: 14-10126 Document: 00513132667 Page: 18 Date Filed: 07/28/2015
No. 14-10126

19

Shepherd, 591 F.3d at 454); see also Duvall, 631 F.3d at 208. Indeed, unlike 

the plaintiff in Shepherd, the Plaintiffs here have not presented evidence 

sufficient to demonstrate that “serious injury and death were the inevitable 

results of the jail’s” staffing practices. Shepherd, 591 F.3d at 454; see also 

Duvall, 631 F.3d at 208 (finding a de facto policy of exposing inmates to a

disease where “the Jail experienced around 200 infections per month,” and this

“bizarrely high incidence” of the disease was known to the County). Plaintiffs’

evidence of one other death that took place in the jail four month prior, is not 

sufficient to show that the jail’s medical staffing was constitutionally

inadequate.9 Shepherd, 591 F.3d at 454 (“[I]solated examples of illness, injury, 

or even death, standing alone, cannot prove that conditions of confinement are 

constitutionally inadequate.”).

Our court does not downplay the tragic death of Wilbert Henson, see 

Callahan, 440 F. App’x at 354 (“On appeal, we granted Krajca qualified 

immunity, finding her actions indicative of negligence, gross negligence, or 

malpractice, but not rising to the level of deliberate indifference to Henson’s 

rights.”), however, “the inquiry of federal courts into prison management must 

be limited to the issue of whether a particular system violates any prohibition 

 

never presented evidence of these subsequent occurrences to the district court. See Stults v. 

Conoco, Inc., 76 F.3d 651, 657 (5th Cir. 1996) (“[O]n summary judgment . . . this court . . . 

will not consider evidence or arguments that were not presented to the district court for its 

consideration in ruling on the motion.” (internal citation and quotation marks omitted)). 

9 Plaintiffs also presented two expert reports, that detailed Henson’s experience in the 

jail and explained how the medical care that Henson received, or did not receive, “caused or 

significantly contributed to” his death. According to these reports, the nurses who 

encountered Henson in the jail “provided markedly substandard nursing care which was 

grossly inadequate in failing to conform to acceptable and prevailing practice of nursing care.” 

Further, they assert that “the failure to adequately treat [Henson’s] lung condition caused 

unnecessary pain and suffering and may have been a direct and proximal cause of his death.” 

By focusing on the deficient responses of the individual staff, and particularly the nurses who 

allegedly failed to conform to the standard of care expected of LVNs, however, these reports 

support Plaintiffs’ abandoned episodic-acts-or-omissions claims rather than a conditions-ofconfinement claim against Wichita County.

 Case: 14-10126 Document: 00513132667 Page: 19 Date Filed: 07/28/2015
No. 14-10126

20

of the Constitution.” Bell, 441 U.S. at 562. Plaintiffs’ evidence falls short of 

proving that the Wichita County jail’s medical system and staffing policies 

amounted to punishment, in violation of Henson’s constitutional rights. 

CONCLUSION

For the reasons above, we AFFIRM the district court’s order granting 

summary judgment in favor of defendants. 

 Case: 14-10126 Document: 00513132667 Page: 20 Date Filed: 07/28/2015