Opinion ID: 2821159
Heading Depth: 2
Heading Rank: 4

Heading: Wichita County

Text: 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 13 Case: 14-10126 Document: 00513132667 Page: 14 Date Filed: 07/28/2015 No. 14-10126 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 14 Case: 14-10126 Document: 00513132667 Page: 15 Date Filed: 07/28/2015 No. 14-10126 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.”). 15 Case: 14-10126 Document: 00513132667 Page: 16 Date Filed: 07/28/2015 No. 14-10126 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. 16 Case: 14-10126 Document: 00513132667 Page: 17 Date Filed: 07/28/2015 No. 14-10126 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, 17 Case: 14-10126 Document: 00513132667 Page: 18 Date Filed: 07/28/2015 No. 14-10126 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 18 Case: 14-10126 Document: 00513132667 Page: 19 Date Filed: 07/28/2015 No. 14-10126 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. 19 Case: 14-10126 Document: 00513132667 Page: 20 Date Filed: 07/28/2015 No. 14-10126 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.