RECOMMENDED FOR FULL-TEXT PUBLICATION 

Pursuant to Sixth Circuit I.O.P. 32.1(b) 

File Name: 18a0002p.06 

UNITED STATES COURT OF APPEALS

FOR THE SIXTH CIRCUIT 

MELISA RICHMOND, 

Plaintiff-Appellant, 

v. 

RUBAB HUQ, et al., 

Defendants-Appellees. 

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No. 16-2560 

Appeal from the United States District Court 

for the Eastern District of Michigan at Ann Arbor. 

No. 5:14-cv-14892—John Corbett O’Meara, District Judge. 

Argued: July 28, 2017 

Decided and Filed: January 3, 2018 

 Before: MOORE, STRANCH, and DONALD, Circuit Judges 

_________________ 

COUNSEL 

ARGUED: Kenneth D. Finegood, KENNETH D. FINEGOOD, PLC, Southfield, Michigan, for 

Appellant. Davidde A. Stella, WAYNE COUNTY CORPORATION COUNSEL, Detroit, 

Michigan, for Appellees. ON BRIEF: Kenneth D. Finegood, KENNETH D. FINEGOOD, 

PLC, Southfield, Michigan, for Appellant. Davidde A. Stella, WAYNE COUNTY 

CORPORATION COUNSEL, Detroit, Michigan, for Appellees. 

______________________ 

AMENDED OPINION 

______________________ 

 BERNICE BOUIE DONALD, Circuit Judge. Plaintiff Melisa Richmond was 

incarcerated in the Wayne County Jail from December 26, 2012 through February 13, 2013. 

>
No. 16-2560 Melisa Richmond v. Rubab Huq, et al. Page 2

While in the custody of the Jail, Richmond received treatment for a self-inflicted burn wound on 

her chest as well as for psychological needs. Richmond contends that she received 

constitutionally inadequate treatment for her burn wound, which necessitated skin grafting 

surgery shortly after her release from the Jail’s custody. She also contends that she was 

unconstitutionally deprived of her psychiatric medication for over two weeks while in custody. 

The district court below granted summary judgment in favor of the Defendants on the grounds 

that Richmond failed to show a constitutional violation. For the reasons described below, we 

REVERSE in part and AFFIRM in part the ruling of the district court. 

I. 

A. 

Plaintiff Melisa Richmond was arrested on December 25, 2012 in relation to an altercation 

at a family gathering in the City of Wyandotte, Michigan. After the police arrived at the scene, 

Lance Granata, Richmond’s adult son, engaged in a verbal and physical altercation with the 

responding officers, who used a taser to subdue Mr. Granata. Witnessing this altercation, 

Richmond attempted to interfere with the arresting officers, at which point she was arrested and 

taken into custody. While in the police cruiser after her arrest but before her booking, Richmond 

suffered a self-inflicted burn wound as a result of setting her seatbelt on fire allegedly in an 

attempt to free herself and reunite with her son. After discovering and extinguishing the fire, 

police officers transported Richmond to Henry Ford Wyandotte Hospital for treatment. At the 

hospital, Richmond was treated for first to second degree burns and discharged into police 

custody. The treating physician at the hospital prescribed Richmond silvadene cream to be 

applied twice a day.1

 Following her discharge that evening, Richmond was taken to the city jail. 

The next day, December 26, 2012, Richmond was arraigned and placed in the custody of the Jail, 

where she remained until being released on bond on February 13, 2013. 

On December 26, 2012, after her arraignment, Richmond was screened for medical and 

mental health issues by a member of the Jail medical staff. The screener took note of 

 1

Although these instructions require that Richmond’s dressing be changed twice daily, once she arrived at 

the Jail, Richmond was prescribed once a day dressing changes. This once-a-day instruction was confirmed after 

Richmond’s January 11 visit to the Jail clinic.
No. 16-2560 Melisa Richmond v. Rubab Huq, et al. Page 3

Richmond’s burn wound as well as her previous mental health history and designated that 

follow-up medical and mental health evaluations would be necessary. The same evening, 

Defendant-Appellee Nurse Shevon Fowler examined Richmond, changed her wound dressing, 

referred her to a psychiatric social worker, and paged the on-call doctor, who in turn ordered 

once daily, rather than twice daily, dressing changes and prescribed her Lortab for pain.2 On 

December 27, Richmond received two doses of Lortab and Defendant-Appellee Nurse Maxine 

Hawk changed her dressing. On December 28, Richmond received three doses of Lortab and 

was seen by Defendant-Appellee Dr. Rubab Huq, who prescribed Motrin and antibiotics to 

prevent infection, allegedly changed Richmond’s dressing, and scheduled a follow-up medical 

visit for January 10, 2013. Also on December 28, Richmond received a mental health screening 

by Agron Myftari, a psychiatric social worker. During this screening, Richmond and Myftari 

discussed Richmond’s prior history of bipolar disorder and her then-current medications which 

included Prozac and Xanax. After his screening, Myftari scheduled Richmond for a January 11, 

2013 appointment with a psychiatrist. However, Myftari determined that Richmond was stable 

enough to wait for her psychiatric appointment without medication, and that if her condition 

changed, Richmond could be admitted to the mental health inpatient unit immediately. 

 On December 29, Richmond received three doses of Lortab. However, she did not 

receive a complete dressing change because Defendant-Appellee Nurse Jacqueline Lonberger 

was allegedly intentionally aggressive while cleaning the wound, causing unnecessary pain. 

After advising Richmond that some pain was inevitable while cleaning a wound such as hers, 

Nurse Lonberger allowed Richmond to return to her cell without a dressing change, noting that 

Richmond did not present symptoms that would require a more drastic treatment, such as 

hospitalization. On December 30, Richmond received two doses of Lortab, and Nurse Lonberger 

changed her dressing. From December 31, 2012 through January 4, 2013, Richmond received 

Lortab twice a day and had her dressing changed by Nurse Hawk, with the exception of January 

3, when Richmond missed her scheduled dressing change because she was in court. 

 2

Richmond was prescribed 1 tablet of Lortab every eight hours, for a total of three daily doses. However, 

Jail policy was to not wake inmates if they were sleeping when pain medication was to be administered. 
No. 16-2560 Melisa Richmond v. Rubab Huq, et al. Page 4

 On January 5, Richmond received two doses of Lortab, and her dressing was changed by 

Defendant-Appellee Medical Assistant Danielle Allen. On January 6, Richmond received two 

doses of Lortab, but there is no indication that her dressing was changed. On January 7, 

Richmond received three doses of Lortab, and her dressing was again changed by Allen. That 

day, Richmond also saw Defendant-Appellee Patricia Rucker, another psychiatric social worker, 

regarding the Jail’s failure to provide her psychiatric medication. Because Richmond stated that 

she had not yet been evaluated, Rucker sent Richmond down to the mental health unit for 

another screening. During this second mental health screening, a third social worker, Jim Gilfix, 

determined that Richmond was stable and could await her previously scheduled appointment 

without any psychiatric medication, even though he was aware that Richmond had been taking 

Prozac and Xanax prior to being taken into custody. On January 8, Richmond received three 

doses of Lortab, but there is no indication that her dressing was changed. On January 9, 

Richmond received three doses of Lortab, and Allen again changed her dressing. On January 10, 

Richmond received two doses of Lortab, but did not receive her daily dressing change because 

she was in court. 

 On January 11, the day of Richmond’s follow-up physical and psychiatric evaluations, 

she received two doses of Lortab. Prior to her evaluations, Richmond was triaged by DefendantAppellee Nurse April Williams, who examined her wound. Immediately afterwards, Richmond 

was seen by Defendant-Appellees Nurse Practitioner Marie Shoulders and Dr. Thomas Clafton. 

Nurse Shoulders testified that she changed the dressing during the examination, but this change 

is not reflected in Richmond’s chart. After this visit, Richmond was prescribed additional 

medication, including silvadene ointment to be used during the once-daily dressing changes. 

Nurse Shoulders testified that her post-visit notation would have clarified any confusion caused 

by a January 9 note, allegedly included in Richmond’s chart by mistake, which required twice 

daily dressing changes. Later in the afternoon of January 11, Richmond was seen by psychiatrist 

Dr. Lisa Hinchman, who diagnosed Richmond with bipolar disorder, depression, and Post 

Traumatic Stress Disorder. Dr. Hinchman prescribed medication to treat Richmond’s mental 

ailments, but she did not prescribe Xanax, Prozac, or their generic equivalents—the medication 

Richmond indicated she had been taking prior to her incarceration. Richmond makes no further 

claims regarding her psychiatric treatment after Dr. Hinchman’s treatments. 
No. 16-2560 Melisa Richmond v. Rubab Huq, et al. Page 5

 On January 12, Richmond received three doses of Lortab, and her dressing was changed. 

Richmond received three doses of Lortab on January 13 and two doses on January 14. After 

January 14, Richmond was switched to over the counter pain medication that could be kept in 

her cell. There is no indication that Richmond’s dressing was changed on January 13, 14, 15, 17 

or 18. Richmond’s dressing was changed by the Jail staff on January 16, 19, 20, 21, and 22. The 

notes from January 21 indicate that Richmond was provided the supplies necessary to begin 

changing her dressing herself. On January 27, Richmond was again provided with the supplies 

necessary to change her dressing on her own. On January 29, Richmond visited the Jail clinic 

for a scheduled appointment. She was triaged by Defendant-Appellee Nurse Felecia Coleman 

before being seen by Nurse Shoulders. Nurse Shoulders noted Richmond’s claims that she had 

not had the supplies to clean and dress her wound for the past week, but determined that the 

wound was in various stages of healing and was not infected. Nurse Shoulders explained to 

Richmond that she was to change the dressing twice daily and noted that Richmond expressed an 

understanding and willingness to comply with these instructions. Nurse Shoulders also testified 

that her practice would have been to change Richmond’s dressing at this visit. There is no record 

of any further encounters between Richmond and the Jail’s medical staff prior to Richmond’s 

release on February 13. 

 Richmond made a consistent effort to report problems with her treatment. The record 

contains her “kites” or grievances, which are dated January 7, 13, 19, 23, and 24. In each kite, 

Richmond noted how the medical care provided to her by the Jail fell short of what had been 

ordered at the hospital and/or by the Jail physicians. Specifically, Richmond noted that the 

medical staff failed to change her dressing, that she had been forced to wear an old and dirty 

dressing on her wound, that she feared her wound was infected, and that she did not receive 

medication prescribed by the Jail doctors. These kites conflict with some of the Jail’s internal 

logs regarding the care Richmond received. 

 After her release, Richmond saw Dr. Andrei Katychev regarding her wound, which he 

cleaned and examined. Dr. Katychev noted that parts of the wound had still not healed, but he 

did not note any sign of infection. Dr. Katychev referred Richmond to the Detroit Medical 

Center Burn Center. During her visit to the Burn Center, Richmond was informed that she 
No. 16-2560 Melisa Richmond v. Rubab Huq, et al. Page 6

would need a skin graft because a portion of her wound was not healing by itself. Richmond 

underwent the grafting procedure on February 22, 2013. 

B. 

 Richmond filed the underlying suit on December 24, 2014, alleging violations of her 

Eighth Amendment right to be free from cruel and unusual punishment. Her claims arise out of 

the medical treatment she received while in the Jail’s custody from December 26, 2012 through 

February 13, 2013. Specifically, she alleges that the Jail’s medical staff did not provide the 

prescribed number of dressing changes and doses of medication. She also contends that the Jail 

violated her Eighth Amendment right by not providing her psychiatric treatment or medication 

during the first three weeks that she was in custody and that Wayne County is liable as a 

municipality for the practice followed by the Jail’s psychiatric social workers of delaying 

prisoner’s access to their psychiatric medication. 

II. 

This Court reviews a district court’s grant of summary judgment de novo. Watson v. 

Cartee, 817 F.3d 299, 302 (6th Cir. 2016). Summary judgment is only appropriate where there 

is “no genuine issue as to any material fact” and defendants are “entitled to judgment as a matter 

of law.” Fed. R. Civ. P. 56(a). A genuine issue of material fact exists where “the evidence is 

such that a reasonable jury could return a verdict for the nonmoving party.” Anderson v. Liberty 

Lobby, Inc., 477 U.S. 242, 248 (1986). In determining “whether the evidence presents a 

sufficient disagreement to require submission to a jury or whether it is so one-sided that one 

party must prevail as a matter of law,” this Court must view all of the evidence and draw all 

reasonable inferences in the light most favorable to the non-moving party. Id. at 251–52, 255. 

The Eighth Amendment provides an inmate the right to be free from cruel and unusual 

punishment. “[A] prisoner’s Eighth Amendment right is violated when prison doctors or 

officials are deliberately indifferent to the prisoner’s serious medical needs.” Comstock v. 

McCrary, 273 F.3d 693, 702 (6th Cir. 2001) (citing Estelle v. Gamble, 429 U.S. 97, 103 (1976)). 

The clearly established right to be free from deliberate indifference to medical needs extends to 
No. 16-2560 Melisa Richmond v. Rubab Huq, et al. Page 7

an inmate’s psychiatric needs. Id. (citing Waldrop v. Evans, 871 F.2d 1030, 1033 (11th Cir. 

1989)); see also Clark-Murphy v. Foreback, 439 F.3d 280, 292 (6th Cir. 2006). 

An Eighth Amendment claim on these grounds is comprised of an objective and a 

subjective component. Id. at 286. The objective component requires the plaintiff to show that 

the medical need at issue is “sufficiently serious.” Farmer v. Brennan, 511 U.S. 825, 834 

(1994). Thus, “a prison official’s act or omission must result in the denial of the minimal 

civilized measure of life’s necessities.” Id. (citations and internal quotation marks omitted). 

Further, this Court has held that “a medical need is objectively serious if it 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.’” Blackmore v. Kalamazoo Cty., 

390 F.3d 890, 897 (6th Cir. 2004) (quoting Gaudreault v. Municipality of Salem, 923 F.2d 203, 

208 (1st Cir. 1990)); see also Friend v. Rees, 779 F.2d 50, 1985 WL 13825, at *3 (6th Cir. Oct.1, 

1985)). In addition, “[w]e have held that a prisoner’s ‘psychological needs may constitute 

serious medical needs, especially when they result in suicidal tendencies.’” Comstock, 273 F.3d 

at 703 (quoting Horn v. Madison Cty. Fiscal Ct., 22 F.3d 653, 660 (6th Cir.1994)). 

Richmond’s claims center around the Jail staff’s failure to change her dressings as 

prescribed, to provide her with pain medication as prescribed, and to provide her with psychiatric 

medication for the first three weeks of her incarceration in spite of their knowledge that she had 

been taking such medication prior to her incarceration. Like the doctors at the Henry Ford 

Wyandotte Hospital, the Jail’s own physicians determined that Richmond’s burn wound required 

daily treatment. Indeed, Richmond’s burn was serious enough to require a skin graft after her 

release. Likewise, both outside physicians and the Jail psychiatrist, Dr. Hinchman, determined 

that Richmond needed treatment in the form of medication to manage her psychiatric needs. The 

gravity of Richmond’s mental health needs is evidenced by the burn itself, which was the 

product of self-harm caused when Richmond lit the seatbelt restraining her on fire. The Jail’s 

intake records also note that Richmond reported her previous attempted suicide. Defendants do 

not challenge Richmond’s contention that these medical needs are “sufficiently serious” to 

satisfy the objective component. Thus, both Richmond’s physical and mental ailments constitute 

serious medical needs so as to satisfy the objective component. 
No. 16-2560 Melisa Richmond v. Rubab Huq, et al. Page 8

The subjective component requires a showing that the “official kn[ew] of and 

disregard[ed] an excessive risk to inmate health or safety.” Farmer, 511 U.S. at 837. “[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. “An express intent to 

inflict unnecessary pain is not required.” Whitley v. Albers, 475 U.S. 312, 319 (1976) (citation 

omitted). Rather, “obduracy and wantonness” are required to make a showing of deliberate 

indifference. Boretti v. Wiscomb, 930 F.2d 1150, 1153 (6th Cir. 1991). “[A]n official’s failure 

to alleviate a significant risk that he should have perceived but did not, while no cause for 

commendation, cannot under our cases be condemned as the infliction of punishment.” Farmer, 

511 U.S. at 838. 

Failure by a jail medical staff to adhere to a prescribed course of treatment may satisfy 

the subjective component of an Eighth Amendment violation. We have held that “a prisoner 

who suffers pain needlessly when relief is readily available has a cause of action against those 

whose deliberate indifference is the cause of his suffering.” Boretti, 930 F.2d at 1154-55. This 

Court has found deliberate indifference where the medical staff allegedly refused to examine or 

change the dressing for a prisoner’s wound altogether in spite of several direct requests. Id. at 

1154. Further, the “interruption of a prescribed plan of treatment could constitute a 

constitutional violation.” Id. (citing Estelle, 429 U.S. at 105). “The fact that the wound healed is 

not dispositive” of whether the defendant was deliberately indifferent to the prisoner’s serious 

medical need, as the “pain and mental anguish” endured is itself sufficient to constitute cruel and 

unusual punishment. Id. at 1154-55; see also Westlake v. Lucas, 537 F.2d 857, 860 (6th Cir. 

1976). However, this Court “distinguish[es] between cases where the complaint alleges a 

complete denial of medical care and those cases where the claim is that a prisoner received 

inadequate medical treatment,” such that where medical care is merely inadequate, this Court is 

“generally reluctant to second guess medical judgments.” Asplaugh v. McConnell, 643 F.3d 162, 

169 (6th Cir. 2011) (quoting Westlake, 537 F.2d at 860 n.5). Nevertheless, treatment may be 

constitutionally impermissible when it is “so woefully inadequate as to amount to no treatment at 

all.” Id. With these standards in mind, we turn to the subjective culpability of the Jail 

Defendants who were responsible for treating Richmond during her confinement. 
No. 16-2560 Melisa Richmond v. Rubab Huq, et al. Page 9

A. Defendant Dr. Thomas Clafton 

Dr. Clafton was the Medical Director of the Wayne County Jail at the time Richmond 

was in the Jail’s custody. Through his position, Dr. Clafton was responsible for the daily 

medical care of the inmates in the Jail. Dr. Clafton saw Richmond during her January 11 followup medical appointment. At that point, Richmond’s medical records showed that her dressing 

had not been changed on six out of the sixteen days she had been in custody and that she had 

missed ten out of 48 dosages of Lortab. Richmond had also started to complain of inadequate 

treatment by January 11. However, there is nothing in the record to suggest that Dr. Clafton did 

anything to determine why Richmond’s dressing had not been changed on certain days or took 

any steps to ensure that his order regarding dressing changes and pain medication would be 

implemented every day as prescribed. Richmond argues that this is enough to constitute 

deliberate indifference to her serious medical needs. 

It is insufficient for a doctor caring for inmates to simply provide some treatment for the 

inmates’ medical needs; rather, “the doctor must provide medical treatment to the patient without 

consciously exposing the patient to an excessive risk of serious harm.” LeMarbe v. Wisneski, 

266 F.3d 429, 439 (6th Cir. 2001). Richmond need not show that any of the Jail staff 

consciously ignored her, “only that [her] serious medical needs were consciously disregarded.” 

Id. (citations omitted). The Boretti Court held that the evidence of the lack of the provision of 

care, in spite of evidence of the development of “an ongoing medical plan for the treatment of 

plaintiff’s wound” and in spite of the fact that the wound healed without infection, may be the 

basis of a claim of “deliberate indifference to serious medical needs.” Boretti, 930 F.2d at 1154. 

At the time of Richmond’s January 11 appointment with Dr. Clafton and Nurse Shoulders, 

Richmond’s medical records show that the Jail staff failed to change Richmond’s dressing six 

times during her sixteen day confinement. Richmond also testified that she sought additional 

treatment from Dr. Clafton as late as January 24th, by which point the Jail staff had failed to 

change Richmond’s dressing on at least five additional occasions.3

 After his first visit with her, 

Dr. Clafton did order that Richmond’s existing plan of treatment be continued. However, there 

 3

The staff missed two additional doses of Lortab after January 11, but by January 24 Richmond was 

capable of keeping her pain medication in her cell. 
No. 16-2560 Melisa Richmond v. Rubab Huq, et al. Page 10

is a question of fact regarding whether he reviewed Richmond’s chart, which showed that the 

plan of treatment had not been strictly been followed—that question is material to the 

determination of whether Dr. Clafton consciously disregarded the risk that Richmond’s serious 

medical need may not receive the treatment prescribed. 

The Defendants assert that Richmond’s claims against Dr. Clafton boil down to a 

disagreement over the adequacy and type of treatment Dr. Clafton ordered. Accordingly, the 

Defendants argue, this Court should be reluctant to second guess the Jail staff’s medical 

judgments “unless the medical treatment is so woefully inadequate as to amount to no treatment 

at all.” Asplaugh, 643 F.3d at 169. The Defendants are correct that to the extent Richmond 

challenges the adequacy of her treatment, this Court is deferential to the judgments of medical 

professionals. However, as noted above, Richmond also argues that Dr. Clafton “fail[ed] to 

provide the care that was ordered.” See Appellant Brief at 42. As discussed, there is a question 

of fact whether Dr. Clafton viewed Richmond’s chart. A reasonable jury could find that Dr. 

Clafton reviewed or should have reviewed Richmond’s chart, which would have made him 

aware of the risk that the Jail medical staff had and would continue to fail to adhere to his 

prescribed plan of care, and that he subsequently disregarded that risk by failing to ensure that 

his orders were implemented as prescribed.4

 This is especially true in light of Richmond’s welldocumented complaints. Such a finding of the failure to provide the prescribed plan of treatment 

may form the basis of a claim for deliberate indifference to an inmate’s serious medical needs. 

Boretti, 930 F.2d at 1154. Thus, summary judgment in favor of Dr. Clafton on this claim is 

inappropriate. 

Richmond also claims that Dr. Clafton violated her Eighth Amendment right by not 

providing her with timely access to her psychiatric medication. However, Dr. Clafton treated 

Richmond on the same day that she was scheduled to see the psychiatrist, Dr. Hinchman. There 

is nothing in the record to suggest that Dr. Clafton could have provided Richmond with 

psychiatric medication sooner than Dr. Hinchman, whose care Richmond found to be 

 4

Because Dr. Clafton knew that Richmond's burn constituted a serious medical need, a reasonable jury 

could conclude that failing to review Richmond's existing plan of treatment constituted deliberate indifference and 

"consciously expos[ed] the patient to an excessive risk of serious harm." See LeMarbe, 266 F.3d at 439. 
No. 16-2560 Melisa Richmond v. Rubab Huq, et al. Page 11

satisfactory. As such, the district court properly granted summary judgment to Dr. Clafton on 

claims related to the timely provision of Richmond’s psychiatric medication. 

B. Dr. Rubab Huq 

Dr. Huq was employed as a physician serving the inmates of Wayne County Jail at the 

time of Richmond’s incarceration. Dr. Huq examined Richmond on December 28, 2012. During 

this visit, Dr. Huq observed the burn wounds on Richmond’s chest, prescribed additional 

medication to ward off infection, and scheduled a follow-up appointment for January 10, 2013. 

Unlike the case with Dr. Clafton, at the time Dr. Huq treated Richmond, the Jail medical staff 

had yet to miss a dressing change, although it had missed one dosage of pain medication. 

Although there is some dispute over whether Dr. Huq herself changed Richmond’s dressing that 

day, the record does not support a finding that Dr. Huq was aware of the risk that the prescribed 

course of treatment might go unimplemented. 

Richmond also argues that Dr. Huq could have been more aggressive in treating her 

wounds; specifically, Dr. Huq could have prescribed more pain medication or recommended that 

Richmond be transferred to a burn center. However, as the Defendants note, “[w]here a prisoner 

alleges only that the medical care received was inadequate, federal courts are generally reluctant 

to second guess medical judgments unless the medical treatment is so woefully inadequate as to 

amount to no treatment at all.” Asplaugh, 643 F.3d at 169. Richmond does not contend that the 

plan of treatment prescribed by Dr. Huq was so inadequate as to amount to no treatment at all, 

but rather that the plan was both insufficient and not fully implemented by others. However, it 

was not Dr. Huq’s role to implement the course of treatment, and there are no facts in the record 

to suggest that Dr. Huq was ever aware that the treatment was not being implemented as he 

prescribed. Further, Dr. Huq scheduled a follow-up appointment for Richmond presumably to 

monitor the healing process. Regarding the necessity of a burn specialist, both Dr. Huq and the 

hospital physician who had recently released Richmond into the Jail’s custody determined that 

such a specialist was not necessary. It would be improper for this court to overturn their medical 

judgment. Thus the district court correctly granted summary judgment on Richmond’s claims 

against Dr. Huq related to the treatment of her burn. 
No. 16-2560 Melisa Richmond v. Rubab Huq, et al. Page 12

However, unlike Dr. Clafton, there is a question of fact as to whether Dr. Huq was made 

aware of Richmond’s need for psychiatric medication well in advance of Richmond’s visit with 

Dr. Hinchman. The record from Nurse Fowler’s first visit with Richmond on the day Richmond 

was brought into the Jail’s custody indicates that Richmond had been on Prozac and Xanax prior 

to entering into the custody of the Jail and that her last dose was taken on December 25, 2012. 

Although this notation was in Richmond’s records, it is not clear from the record whether Dr. 

Huq actually reviewed that particular document. A “prison official[] who ha[s] been alerted to a 

prisoner’s serious medical needs [is] under an obligation to offer medical care to such a 

prisoner.” Comstock, 273 F.3d at 702 (citing Danese v. Asman, 875 F.2d 1239, 1244 (6th Cir. 

1989)). This obligation extends to an inmate’s serious psychiatric needs. Id; see also ClarkMurphy, 439 F.3d at 292. A reasonable jury could find that Dr. Huq was aware of Richmond’s 

serious need for psychiatric medication, as evidenced by Nurse Fowler’s notation, and that she 

failed to take reasonable steps to ensure that Richmond received her medication, such as 

prescribing them herself or even simply requesting that a nurse check with Richmond’s outside 

doctor or pharmacy to verify her prior prescriptions. Because there is a question of fact as to 

whether Dr. Huq was deliberately indifferent to Richmond’s serious medical need, summary 

judgment is not appropriate on this issue. 

C. Agron Myftari 

Defendant-Appellee Myftari was employed as a psychiatric social worker at the time of 

Richmond’s incarceration in the Jail. As a psychiatric social worker, Myftari was not able to 

prescribe medication himself. Rather, in that position, Myftari was responsible for providing 

psychiatric evaluations of inmates and determining the extent of their psychiatric needs. If 

Myftari determined that an inmate required psychiatric care, he would place that inmate either in 

the Mental Health Outpatient Program or the Mental Health Inpatient Program. An inmate 

admitted to the Mental Health Inpatient Program may receive psychiatric medication 

immediately upon arrival in the unit. However, an inmate admitted into the Mental Health 

Outpatient Program must wait until she is seen by a psychiatrist before being prescribed any 

psychiatric medication even where it is known that the inmate was taking medication prior to 

being admitted by the Jail. 
No. 16-2560 Melisa Richmond v. Rubab Huq, et al. Page 13

In the present case, Myftari diagnosed Richmond as bipolar, suffering from depression, 

anxiety and auditory hallucinations. He noted that Richmond had recently been treated for her 

mental health issues and that she was taking Prozac and Xanax, with her last dose being 

December 25, 2012. Notwithstanding these findings, he placed Richmond in the Mental Health 

Outpatient Program, which meant she would not receive any psychiatric medication until after a 

follow-up visit with a psychiatrist, which was scheduled for January 11, 2013. His reasoning for 

this placement was that Richmond had seen a specialist and taken medication just before her 

arrest, that she was stable, and that she would be able to function without medication until her 

follow-up appointment. Notably, Myftari undermined his own reasoning when he also testified 

that if medications such as Richmond’s were stopped, an inmate may begin experiencing 

symptoms, such as depression, mood oscillations, racing thoughts, restlessness, and pressured 

speech within ten days to two weeks. Richmond went seventeen days without medication before 

she even saw a psychiatrist, let alone received medication for her psychiatric needs. 

As discussed above, an inmate has a right to be free from deliberate indifference to his or 

her serious psychological needs. Comstock, 273 F.3d at 702-03. The district court found that 

Richmond failed to present evidence that she suffered from a serious psychological need. 

However, for reasons discussed above, Richmond’s psychiatric needs were sufficiently serious to 

give rise to an Eighth Amendment violation. Richmond showed that at the time of her 

incarceration, she had been diagnosed with mental illness by a physician who determined that 

such illness required treatment in the form of medication. Further, the Jail’s own psychiatrist 

diagnosed Richmond with mental illness requiring treatment in the form of medication. As 

Richmond has shown that she was suffering from mental illness “that ha[d] been diagnosed by a 

physician as mandating treatment,” she has shown that she was suffering from a serious medical 

need. Blackmore v. Kalamazoo Cty., 390 F.3d at 897. 

Further, Myftari’s own testimony regarding the symptoms felt by a person without access 

to their psychiatric medication belies the district court’s conclusion. He testified that in the case 

of patients with depression or bipolar disorder, they can expect the symptoms to return within ten 

days to two weeks without access to medication. Yet, he scheduled Richmond’s appointment 

with Dr. Hinchman—which was the earliest day she could have received any psychiatric 
No. 16-2560 Melisa Richmond v. Rubab Huq, et al. Page 14

medication—for seventeen days after her confinement began. Further, there is evidence in the 

record supporting Richmond’s claim that she did not actually receive any psychiatric medication 

until the prescription ordered by Dr. Hinchman was filled, an additional three days after her 

appointment. Thus, there is evidence in the record to suggest that Myftari knew or had reason to 

know that Richmond had serious psychiatric needs that required treatment; that there was a risk 

that she would begin experiencing symptoms of depression and bipolar disorder days before she 

could expect to receive any medication to treat those ailments; and that he disregarded that risk 

by failing to ensure that Richmond would receive psychiatric medication in a timely manner. 

This showing is sufficient to create a genuine issue of fact as to Richmond’s claim of deliberate 

indifference by Myftari and thereby to survive summary judgment. Farmer, 511 U.S. at 837. 

The Defendants’ argument that, should the need have arisen, Richmond could have been 

admitted to the Mental Health Inpatient Program and received medication immediately, is 

unavailing. To wait until an inmate with a documented history of mental illness has a psychiatric 

episode so severe that it requires inpatient treatment before providing her with any psychiatric 

medication will inevitably result in unnecessary suffering by the inmate. This is the very type 

suffering the Eighth Amendment aims to prevent. Thus, the district court improperly granted 

summary judgment in favor of Mr. Myftari on this issue. 

D. Patricia Rucker 

Patricia Rucker also served as a psychiatric social worker for the Wayne County Jail. 

Like Mr. Myftari, Ms. Rucker was not authorized to prescribe psychiatric medication. She saw 

Richmond on January 7, 2013 at Richmond’s behest, because Richmond had not yet received 

psychiatric medication after being in the custody of the Jail for almost two weeks. After 

examining Richmond, Rucker sent her to a mental health screening under the mistaken 

assumption that Richmond had not yet been screened. Despite the fact that Rucker did not 

review Richmond’s chart or otherwise attempt to verify Richmond’s claims that she had been on 

prescription medication prior to entering the jail’s custody, Rucker responded reasonably. 

Officials do not act with deliberate indifference when they “cho[o]se one medically reasonable 

form of treatment over another.” Comstock, 273 F.3d at 710 (discussing Williams v. Mehra, 

186 F.3d 685 (6th Cir. 1993) (en banc)). Rucker reacted to Richmond’s claim that she required 
No. 16-2560 Melisa Richmond v. Rubab Huq, et al. Page 15

psychiatric medication by referring Richmond for a mental health evaluation. This constitutes a 

“medically reasonable” response, even though Rucker did not personally make an effort to verify 

or secure Richmond’s medications. See Rouster v. Cnty of Saginaw, 749 F.3d 437, 449 (6th Cir. 

2014) (holding that a doctor took “appropriate steps to protect” an inmate where she relied on 

other jail staff to evaluate an inmate’s condition). As such, summary judgment on Richmond’s 

claims against Rucker was appropriate. 

E. Jail Nursing Staff 

The majority of the interactions between Richmond and the Jail medical staff involved 

members of the nursing staff who were responsible for Richmond’s initial screenings as well as 

the implementation of the doctors’ prescribed plan of treatment. Richmond alleges that the 

nursing staff failed to provide her with the pain medication and dressing changes ordered by the 

Jail physicians. She also argues that the nursing staff is complicit in the failure to provide 

psychiatric medication in a timely manner. The Defendants counter by arguing that Richmond 

has failed to identify any individual who refused to provide any part of her prescribed treatment 

and that the nursing staff was not responsible for prescribing her psychiatric medication. 

Seven different members of the nursing staff provided Richmond dressing changes at one 

point or another throughout her incarceration, Nurse Fowler, Nurse Hawk, Nurse Lonberger, 

Medical Assistant Allen, Nurse Shoulders, Nurse Wilson, and Nurse Burnett.5

 The latter two are 

not parties to this suit, so we discuss only the actions of the remaining five. Nurse Fowler last 

encountered Richmond on December 26, 2012, the day after her arrest. At that point, there is 

nothing in the record to suggest that Nurse Fowler knew or should have known of the risk that 

the treatment ordered by the doctor for Richmond would not be implemented as prescribed. As 

such, the district court properly dismissed Richmond’s claim of deliberate indifference against 

Nurse Fowler, as it relates to the treatment of Richmond’s burn wound. 

Nurse Lonberger similarly did not treat Richmond after December 30, 2012, at which 

point Richmond’s treatment had essentially been implemented as ordered. Thus, there is nothing 

 5

Medical Assistant Danielle Allen is included in this count even though she is not a nurse because these 

claims do not involve duties exclusive to nurses as compared to medical assistants. 
No. 16-2560 Melisa Richmond v. Rubab Huq, et al. Page 16

in the record to suggest that Nurse Lonberger was or should have been aware of the risk that 

Richmond’s treatment may not have been provided as prescribed at that point. However, unlike 

Richmond’s claim against Fowler, Richmond specifically alleges that Nurse Lonberger 

otherwise violated her Eighth Amendment rights on one occasion when Nurse Lonberger 

intentionally scrubbed her wound so hard as to cause severe pain while cleaning it. One can 

assume that some pain may be expected while cleaning a wound such as this one, but there is a 

question of fact as to whether Nurse Lonberger’s conduct was intentional to cause unnecessary 

pain to Richmond. While the Court in Asplaugh suggests that we should be hesitant to second 

guess Nurse Lonberger’s medical judgment that some pain would be necessary, 643 F.3d at 169, 

Richmond alleges that Nurse Lonberger was intentionally causing her unnecessary pain, not 

simply that her method of cleaning may have constituted inadequate treatment. A reasonable 

jury could find that intentional scrubbing of a serious wound to cause a prisoner unnecessary 

pain could be characterized as “wanton infliction of unnecessary pain,” in violation of the Eighth 

Amendment. See Estelle, 429 U.S. at 104 (“The infliction of such unnecessary suffering is 

inconsistent with contemporary standards of decency . . . .”). Summary judgment is thus 

inappropriate as to Richmond’s deliberate indifference claim against Nurse Lonberger, given the 

factual dispute that remains.

The district court properly dismissed the claims against Nurse Williams and Nurse 

Coleman. Nurse Williams only interacted with Richmond as a triage nurse prior to Richmond’s 

visit with Nurse Shoulders and Dr. Clafton. Nurse Williams would not have cleaned and 

changed Richmond’s burn wound only for that dressing to be removed and the wound to be 

examined during the subsequent visit with the doctor. Nurse Coleman only saw Richmond on 

January 29, 2013, after Richmond received supplies to self-clean her wound. Further, Nurse 

Coleman only served in an administrative role and would not have cleaned and dressed a wound 

prior to Richmond’s visit with Nurse Shoulders. The record simply does not support a finding 

that either Nurse Williams or Nurse Coleman disregarded a risk to Richmond’s health. Rather, 

they both acted within their limited role of preparing Richmond for her scheduled examinations 

with the responsible medical party. 
No. 16-2560 Melisa Richmond v. Rubab Huq, et al. Page 17

However, by the time Nurses Hawk and Shoulders had their last interactions with 

Richmond, there was evidence from the record to support a claim that they were aware that 

Richmond’s treatment was not being implemented as prescribed. Nurse Hawk changed 

Richmond’s dressing on December 27 and 31, 2012, as well as January 1, 2, and 4, 2013. 

Richmond did not have her dressing changed on January 3, 2013, because she had a court 

appearance at the time Nurse Hawk attempted to change her dressing. However, there is no 

indication in the record that Nurse Hawk attempted to change Richmond’s dressing at a later 

time or attempted to notify any nurses on the next shift regarding the missed dressing change. In 

addition, Richmond’s chart at the time indicated that she had not had a dressing change on 

December 286 or 29, 2012. From this, a reasonable jury could find that Nurse Hawk knew that 

daily dressing changes were prescribed and were important to Richmond’s healing process, but 

that they were not being implemented as ordered. A reasonable jury could also conclude that 

Nurse Hawk, knowing all of this, nevertheless disregarded the risk that Richmond’s burn would 

not heal properly when she failed to ensure that Richmond’s dressing was changed on January 3. 

At that point, Richmond had already started to complain about the Jail’s failure to treat her as 

prescribed. By the time Nurse Shoulders saw Richmond for the first time, Richmond’s medical 

records showed that the Jail medical staff had failed to change her dressing on six different 

occasions. Further, there is some dispute over whether Richmond’s dressing was changed the 

day she saw Nurse Shoulders on January 11. Nurse Shoulders testified that she changed 

Richmond’s dressing herself. However, Richmond disputes this and there is no notation in the 

record reflecting a dressing change on that day. In either case, there is evidence in the record 

from which a jury could find that, like Nurse Hawk, Nurse Shoulders consciously disregarded a 

serious risk that Richmond’s plan of treatment would not be implemented as prescribed, which is 

enough to defeat summary judgment on this claim. 

The grant of summary judgment in favor of Medical Assistant Allen was inappropriate as 

a genuine issue of material fact exists. Allen changed Richmond’s dressing on January 5, 7, 9, 

16, 20, and 21, 2013. There is no reason given for the staff’s failure to change Richmond’s 

 6

Dr. Huq testified that she changed Richmond’s dressing during her visit the day of the 28th, but this is not 

reflected on Richmond’s chart or anywhere else in the record. 
No. 16-2560 Melisa Richmond v. Rubab Huq, et al. Page 18

dressing on January 6, 8, 13, 14, 15, 17, or 18. There is no evidence in the record that Allen, 

who changed Richmond’s dressing most frequently during this two-and-a-half week period, 

made any attempt to address the inconsistent treatment. In fact on January 10, even though 

Richmond had not received a dressing change on January 6 or 8, Allen did not provide a dressing 

change for Richmond because Richmond was in court during Allen’s shift. There is nothing in 

the record to suggest that Allen attempted to provide a dressing change before or after 

Richmond’s court appearance or that Allen attempted to contact the next shift of nurses or 

medical assistants to let them know that Richmond would be in need of a dressing change after 

returning from court. And again, Richmond had started complaining of and documenting 

problematic medical treatment by January 7, right around the time Allen took over the prescribed 

dressing changes. From this record, a reasonable jury could find that Allen was aware of that 

Richmond was suffering from a serious medical need, requiring treatment in the form of daily 

dressing changes, that she was aware of the risk that Richmond faced in not receiving daily 

dressing changes, and that she disregarded that risk on multiple occasions. 

Additionally, Richmond alleges that Nurses Fowler, Hawk, and Shoulders were 

deliberately indifferent to Richmond’s serious psychiatric needs by failing to provide her with 

her psychiatric medication in a timely manner. Specifically, she alleges that these nurses were 

aware of her history of mental illness and yet made no effort to verify her existing medications 

with either her outside doctor or an outside pharmacy. Nurse Fowler examined Richmond on the 

day she was brought into the Jail. During this examination, Richmond informed Nurse Fowler 

that she had been taking Prozac and Xanax, that her last dosage was December 25, 2012, and that 

she was being treated by Team Mental Health. Although Nurse Fowler did recommend that 

Richmond be seen by a psychiatric social worker, the record does not show any attempt to verify 

Richmond’s statement, either by contacting the prescribing pharmacy or by contacting Team 

Mental Health. Nurse Fowler defends this failure by explaining that Richmond was admitted 

late at night, at which point her pharmacy and doctor’s office would have been closed. However, 

Nurse Fowler did not attempt to verify Richmond’s prescriptions at a later date and left no 

notation requesting that a nurse on a subsequent shift perform this verification. Nor is there any 

indication that Nurse Fowler attempted to leave such instructions by another method. 
No. 16-2560 Melisa Richmond v. Rubab Huq, et al. Page 19

Nurse Hawk also had extensive interactions with Richmond between December 27, 2012 

and January 4, 2013. There is a question of fact as to whether Nurse Hawk ever reviewed 

Richmond’s chart for the purpose of ascertaining her medical history or whether she was 

otherwise aware of Nurse Fowler’s notation regarding Richmond’s prior prescription history. 

There is no evidence that Nurse Hawk ever attempted to verify Richmond’s claims, nor that she 

requested that another nurse attempt to do so. On this record, a reasonable jury could find that 

Nurses Fowler and Hawk were aware of Richmond’s serious psychiatric needs and disregarded 

the risk that she may needlessly suffer by going without her psychiatric medication when they 

decided not to verify her claims with an outside pharmacist or doctor’s office, actions that were 

“less than [their] training indicated was necessary.” See Comstock, 273 F.3d at 706. Thus, 

summary judgment on the claims against Nurses Fowler and Hawk relating to Richmond’s 

psychiatric treatment is not appropriate as there are genuine issues of material fact. 

However, the same cannot be said for Nurse Shoulders. She first interacted with Richmond 

on January 11, the day of Richmond’s appointment with Dr. Hinchman. For the reasons 

discussed relating to Richmond’s claims against Dr. Clafton for deliberate indifference to her 

serious psychiatric needs,7

 the district court properly granted summary judgment in favor of 

Nurse Shoulders regarding Richmond’s claims of deliberate indifference to her serious 

psychiatric needs. 

III. 

Because we hold that summary judgment in favor of Defendants was improper at least 

against certain defendants, we must also address the issue of qualified immunity.8

 The doctrine 

of qualified immunity shields officials from civil liability if their conduct “does not violate 

clearly established statutory or constitutional rights of which a reasonable person would have 

known.” Pearson v. Callahan, 555 U.S. 223, 231 (2009) (quoting Harlow v. Fitzgerald, 

457 U.S. 800, 818 (1982)). The qualified immunity analysis has two steps: “(1) whether, 

considering the allegations in a light most favorable to the party injured, a constitutional right has 

 7

See supra Part II.A. 

8

The district court declined to address the issue of qualified immunity based on its finding that Richmond 

failed to show deliberate indifference. 
No. 16-2560 Melisa Richmond v. Rubab Huq, et al. Page 20

been violated, and (2) whether that right was clearly established.” Estate of Carter v. City of 

Detroit, 408 F.3d 305, 310–11 (6th Cir. 2005) (citing Saucier v. Katz, 533 U.S. 194, 201 (2001)). 

First, we must ask “whether the plaintiff has alleged facts which, when taken in the light 

most favorable to her, show that the defendant-official’s conduct violated a constitutionally 

protected right.” Comstock, 273 F.3d at 702. This “collapses into the analysis of whether 

[Richmond] has produced sufficient evidence to show that [Defendants] were deliberately 

indifferent to [Richmond’s] medical needs under the subjective component of the [deliberateindifference] standard.” See Parsons v. Caruso, 491 F. App’x 597, 602 (6th Cir. 2012). Because 

we have already concluded that a jury could find this to be the case with certain claims and 

certain defendants, the only remaining question is whether the right was clearly established. 

For a right to be clearly established, “[t]he contours of the right must be sufficiently clear 

that a reasonable official would understand that what he is doing violates that right.” Comstock, 

273 F.3d at 702 (quoting Anderson v. Creighton, 483 U.S. 635, 640 (1987)). However, we need 

not “find a case in which ‘the very action in question has previously been held unlawful,’ but 

rather, ‘in the light of pre-existing law, the unlawfulness must be apparent.’” Id. (alterations and 

citation omitted). “The proposition that deliberate indifference to a prisoner’s medical needs can 

amount to a constitutional violation has been well-settled since Estelle in 1976.” Parsons, 491 F. 

App’x at 602. This certainly includes the “unnecessary and wanton infliction of pain.” Estelle, 

429 U.S. at 105. It is also well-established that right of a prisoner to be free from deliberate 

indifference extends to psychological needs. Comstock, 273 F.3d at 702. Further, as noted 

above, this Circuit’s precedent is clear that neglecting a prisoner’s medical need and interrupting 

a prescribed plan of treatment can constitute a constitutional violation. See Terrance v. 

Northville Reg’l Psychiatric Hosp., 286 F.3d 834, 844–45 (6th Cir. 2002); Comstock, 273 F.3d at 

702; Boretti, 930 F.3d at 1154. Thus, it was clearly established at the time of Richmond’s 

incarceration in Wayne County Jail that neglecting to provide a prisoner with needed medication, 

intentionally scrubbing her wound to cause unnecessary pain, and failing implement the 

prescribed plan of treatment could constitute a constitutional violation. 
No. 16-2560 Melisa Richmond v. Rubab Huq, et al. Page 21

IV. 

The district court granted summary judgment in favor of Wayne County on Richmond’s 

municipal liability claims on the grounds that because Richmond failed to show that any 

individual defendant was deliberately indifferent to her medical needs, she could not establish 

liability on the part of Wayne County. However, because we have found that Richmond has 

presented issues of material fact regarding whether any individual defendant violated her Eighth 

Amendment rights, her municipal liability claim must be considered in greater detail. 

“A municipality or other local government may be liable under [42 U.S.C. § 1983] if the 

governmental body itself ‘subjects’ a person to a deprivation of rights or causes a person to be 

subjected to such deprivation.” Connick v. Thompson, 563 U.S. 51, 60-61 (2011) (citation 

omitted). To make such a claim, plaintiffs “must prove that ‘action pursuant to official 

municipal policy’ caused their injury.” Id. (quoting Monell v. New York City Dep’t of Soc. 

Servs., 436 U.S. 658, 691 (1978)). Relevant to the case at issue, official municipal policy 

extends to “the acts of its policymaking officials[] and practices so persistent and widespread as 

to practically have the force of law.” Id. “[L]iability can arise and deliberate indifference can be 

shown by proof that the city or county ‘knows that inmates face a substantial risk of serious harm 

and disregards the risk by failing to take reasonable measures to abate it.’” Blackmore, 390 F.3d 

at 900 (quoting Farmer, 511 U.S. at 847). 

Richmond claims that Wayne County is subject to municipal liability because the Jail 

relies on a practice or custom that violates inmates’ Eighth Amendment rights. Specifically, she 

points to the practices of relying on a psychiatric social worker to determine whether an inmate 

needs immediate medication, not providing any medication for a period of weeks to certain 

patients that the psychiatric social worker admits suffer mental illness, and not verifying patients’ 

outside medication before determining whether they need immediate treatment. Richmond 

points to the Jail medical staff’s treatment of her, a single incident of arguably unconstitutional 

activity, and also provides proof that the activity “was [arguably] caused by an existing, 

unconstitutional municipal policy.” City of Oklahoma v. Tuttle, 471 U.S. 808, 823-24 (1985). 

Both Myftari and Rucker testified that the policies Richmond challenges were, in fact, the 

practices of the Wayne County Jail. Although Defendants contend that this is not the case and 
No. 16-2560 Melisa Richmond v. Rubab Huq, et al. Page 22

that Myftari is not qualified to speak to the Jail’s policies, this defense at best points to a question 

of fact on this issue. Because there exist material questions of fact as to whether the actions of 

the Jail medical staff violated Richmond’s right to be free from deliberate indifference to her 

serious medical needs and whether such actions were a part of the practice or custom of the Jail, 

the district court’s grant of summary judgment on this claim was improper. 

V. 

For the foregoing reasons, the district court’s grants of summary judgment to Defendants 

Agron Myftari, Maxine Hawk, Jacqueline Lonberger, Danielle Allen, and Wayne County are 

REVERSED; the district court’s grants of summary judgment to Defendants Rubab Huq, 

Thomas Clafton, Shevon Fowler, and Marie Shoulders are REVERSED in part and 

AFFIRMED in part; the district court’s grants of summary judgment to Defendants Patricia 

Rucker, April Williams, and Felecia Coleman are AFFIRMED; and this action is REMANDED 

to the district court for further proceedings consistent with this opinion.