McBride v. Houston County Health Care Authority et al

Filing 40

OPINION AND ORDER that defendants Greg Benton and City of Dothan's motion to dismiss, etc. 17 is granted in part and denied in part as further set out in order; that defendants Dinesh Karumanchi's and Houston County Health Care Authorit y's motions to dismiss, etc. 10 & 26 are denied and plaintiff McBride's medical-malpractice claims against them are not dismissed and will proceed in this case. Signed by Honorable Judge Myron H. Thompson on 6/7/2013. (Attachments: # 1 Civil Appeals Checklist)(jg, )

IN THE DISTRICT COURT OF THE UNITED STATES FOR THE
MIDDLE DISTRICT OF ALABAMA, SOUTHERN DIVISION

COURTNEY McBRIDE,

)
)
Plaintiff,
)
)
v.
)
)
HOUSTON COUNTY HEALTH CARE )
AUTHORITY d/b/a Southeast )
Alabama Medical Center,
)
et al.,
)
)
Defendants.
)

CIVIL ACTION NO.
1:12cv1047-MHT
(WO)

OPINION AND ORDER
Plaintiff Courtney McBride charges that, while she
was in pre-trial custody in a city jail, the following
defendants subjected her to violations of both federal
and state law: Dothan Police Chief Greg Benton; the City
of

Dothan,

Alabama;

Dr.

Dinesh

Karumanchi;

Houston County Health Care Authority.

and

the

She claims Police

Chief Benton and the City of Dothan deliberately denied
her

needed

medical

treatment

in

violation

of

the

Fourteenth Amendment (as enforced by 42 U.S.C. § 1983)
and state law.

Additionally, she claims that, to the

extent that she was provided limited treatment by Dr.
Karumanchi and the Houston County Health Care Authority
(which operates the Southeast Alabama Medical Center), it
was

inadequate

and

caused

her

to

suffer

serious,

permanent injuries that are compensable under the Alabama
Medical Liability Act (1975 Ala. Code §§ 6-5-480 to –488
and 6-5-540 to -552).

Subject-matter jurisdiction is

proper under 28 U.S.C. §§ 1331 (federal question), 1332
(diversity),

1343

(supplemental).

(civil

rights),

and

1367

The case is now before this court on the

defendants’ motions to dismiss.

For the reasons that

follow, the motions will be granted in part and denied in
part.

I. MOTION-TO-DISMISS STANDARD
In considering a defendant’s motion to dismiss, the
court accepts the plaintiff’s allegations as true, Hishon
v. King & Spalding, 467 U.S. 69, 73 (1984), and construes
the complaint in the plaintiff’s favor, Duke v. Cleland,

2

5 F.3d 1399, 1402 (11th Cir. 1993).

“The issue is not

whether a plaintiff will ultimately prevail but whether
the claimant is entitled to offer evidence to support the
claims.”

Scheuer v. Rhodes, 416 U.S. 232, 236 (1974).

To survive a motion to dismiss, a complaint need not
contain “detailed factual allegations,” Bell Atl. Corp.
v. Twombly, 550 U.S. 544, 545 (2007), “only enough facts
to state a claim to relief that is plausible on its
face.”

Id. at 574.

II. BACKGROUND
McBride’s allegations are as follows:
trial

custody

at

the

Dothan

city

While in pre-

jail,

McBride

was

referred to the Southeast Alabama Medical Center for a
psychiatric evaluation.
Karumanchi,

she

was

There, under the care of Dr.

treated

for

a

major

depressive

disorder, psychotic disorder, and bipolar disorder.

Dr.

Karumanchi prescribed numerous medications, one of which
was Lamictal, a seizure medication.

3

The doctor did not

warn McBride that it had been documented that Lamictal
causes sometimes Stevens-Johnson Syndrome, a severe skin
condition that, if not treated, results in serious and
permanent disfigurement.
Although Dr. Karumanchi did not warn McBride about
the risk of the syndrome, he did warn her that it was
important that the medication be administered properly.
Fearful that jail officials would be unable or unwilling
to administer the medicine properly, McBride and her
mother pleaded with the doctor not to discharge her.
Nevertheless, after a two-week hospitalization, she was
discharged

to

the

jail

with

instructions

that

she

continue taking her prescribed medications, including
Lamictal.

Dr. Karumanchi instructed the officer who was

escorting McBride that, if her condition worsened, she
should be brought to the hospital’s emergency room.
officer

relayed

that

information

to

all

officials, including Police Chief Benton.

4

other

The
jail

Almost

immediately

after

returning

McBride’s physical health worsened.

to

the

jail,

She complained to

officers of a sore throat, difficulty swallowing, and
fever.

Her face became swollen.

Over the following

days, McBride’s condition continued to decline steadily.
By the time six days had passed, she was in extreme pain,
which she described as “9,” on a scale of “1 to 10.”
had

earache,

eating.
disoriented

congestion,

She

was

state.

abnormalities.

fever,

dehydrated
Her

skin

chills,

and

and

in

a

had

started

She

trouble

weakened,
to

show

These were all symptoms of the early

stages of Stevens-Johnson Syndrome.
Throughout that week of declining health, McBride
made repeated requests to numerous jail officials for
medical attention, but she was ignored.

These requests

were relayed to Chief Benton, but he also did nothing.
(The

complaint

is

somewhat

ambiguous

on

the

precise

extent of Benton’s knowledge over the course of these
days, but it does allege clearly that at least some of

5

her complaints were relayed to him.)

The seriousness of

the situation was apparent to other jail detainees who
witnessed McBride’s declining health.

They pleaded with

officers to obtain medical attention for McBride, but no
action

was

attention,

taken.
the

In

jailers

medications properly.

addition

to

did

administer

not

refusing

medical

McBride’s

They gave her medicine at improper

times and, on several occasions, failed to provide her
medicine altogether.
Six

days

after

McBride’s

pleadings

for

medical

attention began, she was finally permitted to see a
doctor at the Southeast Alabama Medical Center emergency
room.

The doctor did not realize that she was in the

early

stages

of

Stevens-Johnson

Syndrome,

instead

diagnosing her with only pharyngitis-tonsilitis (a virus
that causes inflammation of the throat and tonsils),
canker sore (a painful mouth sore), and rash.
returned to the jail that same day.

6

She was

Either that same day or the next (the complaint is
unclear), McBride was released from the jail’s custody.
She returned again to the emergency room (of her own
volition this time) and voiced similar complaints as she
had on the prior visit.

Despite exhibiting classic

symptoms of Stevens-Johnson Syndrome, the hospital staff
again failed to diagnose the condition.

Their questions

to McBride focused on whether she had engaged in rough
sex.

They concluded that McBride had, in addition to the

conditions diagnosed previously, blisters and candidiasis
(a fungal infection) and nothing more.
The next day, McBride made her fourth visit to the
emergency room.

By that time, a rash covered essentially

her entire body; her skin was falling off; and she was in
extreme and excruciating pain.

For the first time,

hospital staff recognized her as suffering from StevensJohnson Syndrome as a result of the Lamictal, and her use
of the medication was discontinued.

7

She was transferred

to the hospital’s intensive-care unit and some time later
to the burn unit.
Today,

as

a

result

of

the

syndrome

being

left

untreated for so long, McBride has severe scarring over
the majority of her body.

She has lost all of her hair

and her nails now grow abnormally.

Her vision has been

weakened, and she no longer menstruates.
constant, extreme pain.

She is under

She contends that, if she had

received earlier and better care, this all could have
been prevented.

III. DISCUSSION
A. Deliberate-Indifference Claim Against
Police Chief Benton
McBride contends that Police Chief Benton violated
her constitutional rights when he, aware of her dire need
for medical care, denied her access to a doctor for
approximately one week.
facts

alleged,

the

Benton responds that, on the

complaint

does

not

make

out

a

plausible claim against him and, alternatively, to the
8

extent

that

it

may,

he

is

nevertheless

immune

from

liability.

1. Sufficiency of the pleading
The deliberate indifference of jail officials to the
serious medical needs of pre-trial detainees violates the
Fourteenth Amendment.

Lancaster v. Monroe Cnty., 116

F.3d 1419, 1425 (11th Cir. 1997).

A jailer acts with

“deliberate indifference” when he knows that a detainee
is in serious need of medical care, but he fails or
refuses to obtain medical treatment.
illustrative cases).

Id. (collecting

A detainee’s need for medical care

is “serious” when, if the need is unmet, it poses a
substantial risk of serious harm.

Taylor v. Adams, 221

F.3d 1254, 1258 (11th Cir. 2000) (citing Estelle v.
Gamble, 429 U.S. 97, 104 (1976), and Farmer v. Brennan,
511 U.S. 825, 834 (1994)).

A need is also “serious” when

it is “so obvious that even a lay person would easily
recognize

the

necessity

for

9

a

doctor's

attention.”

Farrow v. West, 320 F.3d 1235, 1243 (11th Cir. 2003)
(quotation marks and citation omitted).
care

is

ultimately

provided,

a

Where medical

jailer’s

conduct

may

nevertheless be unconstitutional if the treatment was
deliberately

delayed,

“even

for

a

period

of

hours.”

McElligott v. Foley, 182 F.3d 1248, 1255 (11th Cir.
1999); see also id. at 1257 (“A core principle of Eighth
Amendment jurisprudence in the area of medical care is
that prison officials with knowledge of the need for care
may not, by ... delaying care, ... cause a prisoner to
needlessly suffer the pain resulting from his or her
illness.”).
There can be little doubt that McBride’s allegations
make out a claim of deliberate indifference.

According

to her complaint, Chief Benton was made aware that Dr.
Karumanchi had instructed that, if McBride’s condition
worsened in the jail, she should be brought back to the
emergency room and that, regardless, Benton ignored her
pleas for medical attention when her face became swollen,

10

a fever developed, and she began to have difficulty
eating.

Over the following days, according to McBride’s

complaint, her condition worsened further to the point
that

other

detainees

(all

lay

persons,

not

medical

professionals), aware of the obvious need for medical
attention, pleaded with jail officials to obtain medical
care, and Benton still did nothing.
In response, Chief Benton raises several contentions
about the adequacy of McBride’s complaint.

First, he

argues that the complaint’s allegation that he was made
aware of her requests for medical attention is “cryptic,”
“conclusory,” and “implausible” and should therefore be
discounted by this court.
12.

The

court,

Def.’s Br. (Doc. No. 18) at

however,

sees

nothing

cryptic,

conclusory, or implausible about a supervisory official
at a jail being informed of a detainee’s requests for
medical care.
Second, Chief Benton argues that McBride’s complaint
commits a “sleight of hand” by portraying, deceptively,
the

nature

of

Dr.

Karumanchi’s
11

instructions

about

returning McBride to the emergency room if her conditions
worsened.
doctor

According to Benton, the “conditions” the

mentioned

were

exclusively

psychological

(not

physical) conditions; therefore, once McBride’s physical
conditions deteriorated, the jailers had no reason to
think medical care was needed.
contests

Benton’s

Id. at 12-13.

interpretation

of

McBride

the

doctor’s

statement, instead alleging that Dr. Karumanchi asked for
McBride’s return if her “general health” worsened “in
light

of

the

ongoing

prescription

of

Lamictal,”

a

medicine known to create the risk of Stevens-Johnson
Syndrome.

Pl.’s Br. (Doc. No. 23) at 4.

amend

complaint

her

to

eliminate

any

She offers to
possibility

ambiguity, but no amendment is necessary.
previously

any

allegations,
complaint

risk

of

If there was

misunderstanding

that

risk

has

now

alleges

that

Benton

been
had

of

McBride’s

eliminated:

knowledge

of

The
the

doctor’s instructions to return McBride to the emergency
room if her general health worsened and that Benton
deliberately ignored those instructions.
12

Third, Chief Benton contends that, even if he did
ignore for almost a week McBride’s writhing in pain and
begging

to

see

a

doctor,

he

should

not

be

held

responsible for that delay, because, even if he would
have permitted the ailing detainee to go to the emergency
room at an earlier time, it is likely that the doctors
there would have failed to diagnose properly and treat
her Stevens-Johnson Syndrome.
at 14.

Def.’s Br. (Doc. No. 18)

He argues, given that the hospital’s doctors

eventually did misdiagnose the condition, there is no
reason to think they would have done better if afforded
an earlier opportunity.

Id.1

The argument is meritless.

1. The police chief’s brief makes this argument as
follows:
“The complaint does not contain any
factual allegations which plausibly
demonstrate that taking the plaintiff to
the hospital any earlier would have
changed her outcome.... [T]he complaint
alleges that doctors at Southeast
Alabama Medical Center did not diagnose
or
treat
the
plaintiff’s
alleged
condition on two separate hospital
visits that occurred after she contends
(continued...)
13

The police chief’s obligation to provide medical care to
detainees in his custody is not absolved by an assumption
that local doctors will provide negligent and inadequate

1(...continued)
Chief Benton should have taken her to
the hospital. The period in question is
between the plaintiff’s discharge from
the hospital on July 4, 2012 and the
plaintiff’s return to the hospital on
July 10, 2012. The complaint does not
plausibly demonstrate that taking the
plaintiff back to the hospital on July
5, 6, 7, 8 or 9 would have yielded a
different result than occurred when the
plaintiff visited the hospital on July
10 and 11.
On each occasion, the
plaintiff was evaluated by a different
doctor.
On
both
occasions,
the
plaintiff
was
discharged
without
diagnosis
or
treatment
of
Stevens-Johnson Syndrome. The complaint
does not plausibly demonstrate how
taking the plaintiff to the hospital
before July 10--during a period when her
symptoms were admittedly less severe-would have resulted in an earlier
diagnosis and treatment. Based on the
foregoing, Chief Benton moves to dismiss
[the charge] for failure to state a
claim upon which relief can be granted.”
(Doc. No. 18) at 14-15 (emphasis in original).
14

care (even if ex-post circumstances to some extent lend
credence to the assumption).
Chief Benton’s assumption that no good would have
likely come from sending her to the hospital earlier is
debatable.

McBride

contends

that,

if

she

had

been

returned to the hospital the same day she began taking
Lamictal and suffering side effects, the doctors there
would have been more--not less--likely to identify the
real cause of her ailments.

As such, her complaint

charges that Chief Benton, in addition to the doctors, at
least in part, caused her injury.

It must be remembered

that a motion to dismiss is before the court, not a
motion for summary judgment; here, if McBride’s complaint
alleges a plausible claim, the court must allow it to
proceed.

There is no serious question that the complaint

plausibly alleges that Benton contributed to her injury,
and whether that allegation has plausible merit should be
resolved

on

summary

judgment

or

at

trial

after

the

evidence is developed, not on a dismissal motion. The
police chief is on notice of the charges against him, and
15

he may now defend against them on the basis of actual
evidence, not naked speculation.2

2. Qualified immunity
Next, Chief Benton argues that, even if McBride does
allege a viable claim against him, he is immune under the

2. Additionally, McBride’s claim raises the issue of
whether Benton should be held liable for denying McBride
access to medical care regardless of whether his delay
caused her Stevens-Johnson Syndrome to progress to the
point alleged. The Sixth Circuit Court of Appeals has
explained: “Where the seriousness of a prisoner’s needs
for medical care is obvious even to a lay person, the
constitutional violation may arise. This violation is
not premised upon the ‘detrimental effect’ of the delay,
but rather that the delay alone in providing medical care
creates a substantial risk of serious harm. When prison
officials are aware of a prisoner’s obvious and serious
need for medical treatment and delay medical treatment of
that condition for non-medical reasons, their conduct in
causing the delay creates the constitutional infirmity.
In such cases, the effect of the delay goes to the extent
of the injury, not the existence of a serious medical
condition.” Blackmore v. Kalamazoo Cnty., 390 F.3d 890,
899 (6th Cir. 2004); see also Smith v. Carpenter, 316
F.3d 178, 188 (2d Cir. 2003) (holding that “an Eighth
Amendment claim may be based on a defendant's conduct in
exposing an inmate to an unreasonable risk of future harm
and that actual physical injury is not necessary in order
to demonstrate an Eighth Amendment violation”).
16

qualified-immunity

doctrine.

Qualified

immunity

“protects government officials ‘from liability for civil
damages insofar as 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)).

Qualified

immunity, which was once called “good-faith immunity,”
see, e.g., Gomez v. Toledo, 446 U.S. 635, 639-40 (1980)
(“[A] public official[‘s] position might entitle him to
immunity if he acted in good faith.”); Harlow, 457 U.S.
at 807 (referring to “qualified or good-faith immunity”),
essentially seeks to protect government officials from
monetary liability for unexpected changes in the law.
such,

if

a

government

official

is

alleged

to

As

have

violated legal rights that were not “clearly established”
in the law at the time of his challenged conduct, this
court will not make him pay for the lack of foresight.
See Ashcroft v. al-Kidd, 131 S.Ct. 2074, 2085 (2011)
(“Qualified immunity gives government officials breathing
17

room to make reasonable but mistaken judgments about open
legal questions.”).
In

deciding

whether

a

legal

right

was

“clearly

established” in the law, the question before the court is
whether “the state of the law ... gave [the defendant]
fair

warning

that

[his]

alleged

plaintiff] was unconstitutional.”
U.S. 730, 740 (2002).

treatment

of

[the

Hope v. Pelzer, 536

Put another way, “‘[c]learly

established’ for purposes of qualified immunity means
that the contours of the right must be sufficiently clear
that a reasonable official would understand that what he
is doing violates that right.

This is not to say that an

official action is protected by qualified immunity unless
the very action in question has previously been held
unlawful, but it is to say that in the light of preexisting law the unlawfulness must be apparent.”

Wilson

v. Layne, 526 U.S. 603, 614-15 (1999) (punctuation marks
and citations omitted); see also Hope, 536 U.S. at 741
(“[O]fficials can still be on notice that their conduct

18

violates

established

law

even

in

novel

factual

circumstances.”).3
In 1976, the Supreme Court held that “deliberate
indifference to [the] serious medical needs of prisoners”
violates the Constitution.
97, 104 (1976).
countless

Estelle v. Gamble, 429 U.S.

Since then, there have been decades of

judicial

decisions

elaborating

upon

the

government’s obligation to provide for the medical care
of those in its prisons and jails.

By 2012 (the year of

Benton’s alleged conduct), the constitutional rule had
long been “well settled.”

Harris v. Coweta Cnty., 21

3.
Chief Benton disputes this legal standard,
arguing that he is entitled to immunity unless McBride
identifies for the court a case with “indistinguishable
facts.” Def.’s Reply Br. (Doc. No. 28) at 6. That is
not the correct standard.
See Hope, 536 U.S. at 739
(reversing Eleventh Circuit decision that required case
law with “materially similar” facts); McElligott, 182
F.3d at 1260 (“[O]ne simply cannot say that a prisoner
has a clearly established right to adequate psychiatric
care but that that right is not violated by a particular
treatment amounting to grossly inadequate care unless
some prior court has expressly so held on ‘materially
similar’ facts.
Such an approach would add an
unwarranted degree of rigidity to the law of qualified
immunity.”) (quotation marks and citation omitted).
19

F.3d

388,

393

(11th

Cir.

1994);

see

id.

at

393-94

(collecting cases on the evolution of prisoner-medicalneeds jurisprudence).

The court sees nothing about the

allegations in this case that distinguishes it from the
countless

judicial

decisions

elucidating

the

“core

principle” that jailers, “with knowledge of the need for
care may not, by ... delaying care, ... cause a prisoner
to needlessly suffer the pain resulting from his or her
illness.”

McElligott, 182 F.3d at 1257.

Simply put,

Chief Benton is alleged to have, in knowing contravention
of

a

doctor’s

medical

care

to

instructions
a

detainee

getting worse by the day.

to

the

with

contrary,

denied

obvious

ailment

an

If the allegation is true, it

is an obvious constitutional violation.

Cf. Hope, 536

U.S. at 738.4

4.
Chief Benton, quoting language from a prior
Eleventh Circuit opinion, argues that:
“[C]ases
involving a delay in medical treatment” are “highly factspecific and involve an array of circumstances pertinent
to just what kind of notice is imputed to a government
official and to the constitutional adequacy of what was
done to help and when. Most cases in which deliberate
(continued...)
20

Chief Benton, giving the complaint an unjustifiably
cramped reading, understands it to allege that, until the
day in which he permitted McBride to return to the
hospital (about a week after she initially requested it),
she had exhibited nothing more than minor “cold-like
symptoms, which are not a serious medical condition”
triggering a governmental obligation to respond.
Reply Br. (Doc. No. 28) at 16.

Def.’s

He argues, given those

symptoms, existing case law did not put him on notice of
a constitutional obligation to respond.

As an initial

matter, the court is troubled by the police chief’s
characterization of McBride’s symptoms as merely “coldlike.”

The court does not read the complaint the same

4(...continued)
indifference is asserted are far from obvious violations
of the Constitution.” Bozeman v. Orum, 422 F.3d 1265,
1274 (11th Cir. 2005).
Regardless of the accuracy of
that broad description, in dicta, of “most cases,” the
allegations against Benton in this case do, in fact,
amount to an obvious violation. See id. at 1274 (denying
qualified immunity because prison officials “knew [the
prisoner] was unconscious and not breathing and--for
fourteen minutes--did nothing”).
21

way.5 Additionally, Benton’s contention invokes a “highly

5.
The complaint describes McBride’s conditions
leading up to her eventual readmission to the hospital as
follows:
“Almost immediately [after returning to
the jail from her initial stay in the
hospital] her condition worsened. She
began to complain to jailers of a sore
throat, difficulty swallowing and fever.
Her face was swollen.... Over the next
several days, Ms. McBride’s condition
continued to decline....
Ms. McBride
and other detainees who observed her
steadily declining condition pleaded
with
jailers
to
obtain
immediate
attention for Ms. McBride.... Finally,
on July 10, 2012, Ms. McBride was
transported to SAMC Emergency Room. At
that time she complained of sore throat,
difficulty swallowing, trouble eating,
earache, congestion, swollen face, fever
and chills. She was dehydrated. She
was
in
a
weakened,
confused
and
disoriented state. She was in extreme
pain, rating her pain as a nine out of
ten.”
Compl. (Doc. No. 1) ¶¶ 14-17. Benton’s reading of the
complaint as alleging nothing more than “cold-like
symptoms” up until July 10, when “more serious symptoms
[first] emerged” (and Benton was immediately thereafter
taken to the hospital), Def.’s Reply Br. (Doc. No. 28) at
4, does not square with the complaint’s plain description
of her gradually declining condition. See Fed. R. Civ.
P. 8(e) (“Pleadings must be construed so as to do
(continued...)
22

fact-specific

[issue]

and

involve[s]

an

array

of

circumstances pertinent to just what kind of notice is
imputed to [him] and to the constitutional adequacy of
what was done to help and when.”
F.3d

1265,

1274

(11th

Cir.

Bozeman v. Orum, 422

2005).

As

such,

it

is

inappropriate for resolution at the motion-to-dismiss
stage.

See Bannum, Inc. v. City of Fort Lauderdale, 901

F.2d 989, 999 (11th Cir. 1990) (district court, before
discovery, “terminated [the case] at a premature stage”
on the basis of immunity); cf. Todd v. Exxon Corp., 275
F.3d 191, 199 (2d Cir. 2001) (“[C]ourts hestitate to
grant motions to dismiss for failure to plead [issues
requiring] deeply fact-intensive inquir[ies].”). As this
court

reads

the

complaint

to

allege

adequately

a

constitutional violation, the court will not dismiss the
case based on speculation about what the evidence may
eventually show.

5(...continued)
justice.”).
23

3. Individual versus official capacity suits
Finally, there is the issue that Police Chief Benton,
in addition to being sued in his “individual capacity,”
has also been sued in his “official capacity” as a city
agent, while McBride has also named the city itself as a
defendant.

A lawsuit against a municipal officer in his

official capacity is functionally equivalent to suing the
municipality

itself,

and,

therefore,

naming

defendants is redundant and unnecessary.

both

as

See Busby v.

City of Orlando, 931 F.2d 764, 776 (11th Cir. 1991)
(affirming district court’s dismissal of § 1983 claims
against official-capacity defendants, stating, “To keep
both the City and the officers sued in their official
capacity as defendants in this case would have been
redundant

and

possibly

confusing

to

the

jury.”).

Therefore, the court will dismiss the lawsuit against
Benton in his official capacity (but not his individual
capacity) to eliminate the redundancy.
respects,

the

deliberate-indifference

Benton will proceed.
24

In all other
claim

against

B. Deliberate-Indifference Claim Against Police Chief
Benton Based on Supervisor Liability and DeliberateIndifference Claim Against the City of Dothan Based on
Municipal Liability
In addition to claiming that Chief Benton personally
caused her suffering by delaying medical care, McBride
further charges that Chief Benton, in his supervisory
capacity, and the city itself established an austere
policy and custom regarding the provision of medical care
at the jail such that, when she needed medical attention,
all staff at the jail, in addition to Benton himself,
refused affording it to her.

1. Police Chief Benton
Chief

Benton

may

be

personally

supervisory conduct in four ways.
that

Benton

“personally

liable

for

his

McBride may show (1)

participate[d]

in

unconstitutional conduct” of others at the jail.

the
Harper

v. Lawrence Cnty., 592 F.3d 1227, 1236 (11th Cir. 2010).
Or she may show that “there [was] a casual connection
between the [unconstitutional] conduct and [Benton’s]

25

actions, and [t]here are three ways to establish such a
causal connection:” (2) “when a history of widespread
abuse puts the responsible supervisor on notice of the
need to correct the alleged deprivation, and he fails to
do so”; (3) “when a supervisor’s custom or policy results
in deliberate indifference to constitutional rights”; or
(4) “when facts support an inference that the supervisor
directed the subordinates to act unlawfully or knew that
the subordinates would act unlawfully and failed to stop
them

from

doing

so.”

Id.

at

1236

(citation

and

punctuation omitted).
Because Chief Benton is alleged to have personally
participated

in

his

and

his

staff’s

deprivation

of

McBride’s constitutional rights--that is, that he, like
the staff under him, personally knew of her dire need for
medical care and he nevertheless refused to provide it-that is enough to make out adequately a deliberateindifference claim based on supervisor liability.

For

the

not

reasons

already

discussed,

26

Chief

Benton

is

entitled to qualified immunity against that claim.6

Cf.

id. at 1237 (“In our view, our prior pronouncements on
the illegality of delayed or inadequate treatment for
alcohol

withdrawal

should

have

sufficed

to

put

the

supervisor[s] on notice ... that delayed or inadequate
treatment of alcohol withdrawal would be unlawful.

Those

cases should also have put supervisors on notice that
policies or customs of delayed investigation into and

6.
Because Chief Benton is alleged to have
personally participated in the unconstitutional conduct,
the court’s analysis may stop there and need not address
the issue of Benton’s possible liability if a policy or
custom he established resulted in other jail staff
causing a constitutional violation with which the police
chief did not personally participate.
If the facts
ultimately show as much, the qualified-immunity inquiry
becomes more complicated because the question may become,
for example, whether Benton had sufficient notice of his
subordinate’s wrongdoing to require him to modify
existing policies or implement new policies altogether.
Such questions, which are unnecessary to address now
stage, will be evaluated on the basis of the evidence
presented. Cf. Camilo-Robles v. Zapata, 175 F.3d 41, 46
(1st Cir. 1999) (“[T]he extent of a superior’s knowledge
of his subordinate’s proclivities is a central datum in
determining whether the former ought to be liable (or
immune from suit) for the latter's unconstitutional
acts.... [H]owever, the question of notice is hopelessly
factbound.”) (citation omitted).
27

treatment of alcohol withdrawal would be unlawful as
well.”).

2. City of Dothan
Similarly, to hold the city liable, McBride must show
that the city itself, acting through an agent with final
authority,
responsible

whether
for

Chief

an

Benton

official

or

policy

another,
of

was

deliberate

indifference to the medical needs of jail detainees or a
custom of permitting such indifference, and that the
policy

or

custom

was

the

driving

violation to McBride’s rights.

force

behind

the

See, e.g., McDowell v.

Brown, 392 F.3d 1283, 1289 (11th Cir. 2004) (discussing
Monell v. Dep’t of Soc. Serv., 436 U.S. 658 (1978), and
its progeny).

If liability rests on a custom (rather

than an official policy) it is generally necessary to
show a practice that is so “persistent and wide-spread”
that it “takes on the force of law.”
(quotation marks and citations omitted).

28

Id. at 1290

McBride alleges that, regardless of whether Chief
Benton himself knew of her individual need for care, she
was denied care because of a broader policy or custom of
inadequately
policy

so

providing

restrictive

medical
that

care

detainees

to
in

detainees,

a

addition

to

McBride were regularly denied needed access to doctors.
She claims that the defendants inadequately trained jail
staff to address medical needs and inadequately funded
and staffed the jail.

The city argues that McBride’s

allegations are too vague and scarce on detail to amount
to a plausible claim, and should thus be dismissed.
court disagrees.

The

Given that McBride has alleged, in

detail, a pattern of numerous jail officials, including
Benton himself, ignoring her obvious need for medical
attention for an extended period, it is not implausible
that the multiple jailers were acting pursuant to a
common policy or custom, whatever the precise contours
that policy or custom may have.

See Powe v. City of

Chicago, 664 F.2d 639, 650 (7th Cir. 1981) (“[W]here the
plaintiff alleges a pattern or a series of incidents of
29

unconstitutional conduct, then the courts have found an
allegation of policy sufficient to withstand a dismissal
motion.”).
McBride’s allegations of a policy or custom are
sufficiently descriptive for the city to defend against.
Moreover, she could not reasonably be expected to assert
more, given that discovery has not yet occurred.

See

Smith v. Brevard Cnty., 461 F. Supp. 2d 1243, 1250 (M.D.
Fla.

2006)

(Presnell,

J.)

(“Plaintiff

will

have

the

opportunity during discovery to learn the specifics of
the practices and customs that go on inside BCDC, however
these specifics need not be alleged in the Complaint.

To

require such specificity would mean that Plaintiffs would
be required to know the inter-workings of correctional
facilities before they could bring a complaint.

As

correctional facilities are generally closed off from the
public eye, this would be a difficult task at best.”).
In short, McBride has alleged enough to make out
adequately a claim against the city.

30

C. State-Law Claims Against Police Chief Benton
and the City of Dothan
McBride asserts state-law claims of negligence and
wantonness against Chief Benton and the city.

Both

defendants, in response, contend that they are immune
under state law.

McBride concedes that the negligence

and wantonness claims against Benton should be dismissed,
and therefore, the court will dismiss them pursuant to
the parties’ agreement.

However, McBride contests the

city’s purported immunity.
The wantonness claim against the city can easily be
dismissed, as, under Alabama law, “a city cannot be
liable for wanton conduct.”
885

So.

2d

negligence

135,
claim.

142

Hollis v. City of Brighton,

(Ala.

The

2004).

parties

agree

That
that

leaves

the

state-law

immunity does not shield the negligent conduct of a jail
officer.

See Walker v. City of Huntsville, 62 So. 3d

474, 501 (Ala. 2010) (“We now hold that a municipal
jailer who lacks the authority of a police officer cannot
claim immunity under concepts applicable to the immunity

31

of a State agent.”).

Moreover, the parties agree that

the city may be held vicariously liable for the negligent
conduct of its employees, acting in the scope of their
employment, who are not themselves immune, including
jailers.

See City of Lanett v. Tomlinson, 659 So. 2d 68,

70 (Ala. 1995) (under 1975 Ala. Code § 11-47-190, a
“municipality may be liable ... under the doctrine of
respondeat superior for injuries that result from the
wrongful conduct of its agents or officers in the line of
duty”).

Therefore, it seems obvious that McBride has

alleged a viable claim for negligence against the city.
The city’s argument to the contrary relies on a
strained reading of McBride’s complaint.

Construing the

complaint’s language strictly, the city argues that it
pleads only that the city itself “breached a duty to the
plaintiff,” rather than pleading that jailers for whom
the city is vicariously liable breached a duty.
Reply Br. (Doc. No. 28) at 18.
purpose

in

dismissing

the

Def.’s

The court sees little

complaint

over

this

ambiguity, and, thus, the court declines to do so.
32

minor
See

Fed. R. Civ. P. 8(d) and (e); see also 5 Wright & Miller,
Federal Practice and Procedure § 1286 (3d ed. 2004) (“One
of the most important objectives of the federal rules is
that lawsuits should be determined on their merits and
according to the dictates of justice, rather than in
terms of whether or not the averments in the paper
pleadings have been artfully or inartfully drawn.”).
In sum, McBride’s state-law claims against Chief
Benton and the wantonness claim against the city will be
dismissed.

The negligence claim against the city will go

forward, as the city may be held vicariously liable for
the negligent conduct of its jailers.

D. Punitive-Damages Claims Against
the City of Dothan
In

addition

to

other

requested

relief,

McBride

charges that the city should be made to pay punitive
damages.

However, the city is immune from McBride’s

claims for punitive damages under both federal and state
law.

See City of Newport v. Fact Concerts, Inc., 453

33

U.S.

247,

271

(1981)

(federal);

Carson

v.

City

of

Prichard, 709 So. 2d 1199, 1205 (Ala. 1998) (state).
Therefore, McBride’s claims against the city will be
dismissed insofar as they seek punitive damages, but not
insofar as they seek other relief.

E. Medical-Malpractice Claims Against Dr. Karumanchi
and the County Health Care Authority
With a terse, single-sentence request, Dr. Karumanchi
asks this court to dismiss McBride’s medical-malpractice
claim against him because it fails to state a claim upon
which relief can be granted.

In the absence of legal

argument of any sort, this court declines the invitation
to speculate on the grounds, if any, that Dr. Karumanchi
has in mind.

See Fed. R. Civ. P. 7(b)(1)(B) (“A request

for a court order must be made by motion [which] state[s]
with particularity the grounds for seeking the order.”)
(emphasis added).

In the alternative, the doctor asks

that the court sever the claims against him for separate
proceedings.

Again, he offers no explanation as to why

34

that

course

is

proper,

see

Fed.

R.

Civ.

P.

42(b)

(providing grounds for separate trials), and this court
will not guess.
With equally sparse briefing, both Dr. Karumanchi and
the Houston County Health Care Authority contend that the
state-law claims against them predominate substantially
over the federal-law claims, and, therefore, this court
should decline to exercise supplemental jurisdiction over
them.

See 28 U.S.C. § 1367(c)(2) (“The court may decline

to exercise supplemental jurisdiction over a [state-law]
claim if ... the claim substantially predominates over
the ... claims over which the district court has original
jurisdiction.”).

The court disagrees that the state-law

claims predominate here.

Moreover, even if that were the

case, they would still fall properly within the court’s
diversity jurisdiction under 28 U.S.C. § 1332.
Dr. Karumanchi’s and the Houston County Health Care
Authority’s dismissal motions will be denied.

35

***
Accordingly,

it

is

ORDERED

that

defendants

Greg

Benton and City of Dothan’s motion to dismiss, etc. (Doc.
No. 17) is granted in part and denied in part as follows:
(1) Defendant Benton is dismissed insofar as he is
sued in his official capacity.

He remains a defendant in

his individual capacity.
(2) Plaintiff Courtney McBride’s request for punitive
damages against defendant City of Dothan is denied.
(3) Plaintiff McBride’s following claims are not
dismissed and will proceed in this case: (a) the federal
deliberate-indifference claim against defendant Benton in
his individual capacity; (b) the federal deliberateindifference

claim,

based

on

supervisor-liability,

against defendant Benton in his individual capacity; (c)
the

federal

deliberate-indifference

claim,

based

on

municipal-liability, against defendant City of Dothan;
and

(d)

the

state-law

negligence

defendant City of Dothan.

36

claim

against

the

(3) Plaintiff

McBride’s

following

claims

are

dismissed and will not proceed in the case: (a) the
state-law

negligence

and

wantonness

claims

against

defendant Benton and (b) the state-law wantonness claim
against the defendant City of Dothan.
It

is

further

ORDERED

that

defendants

Dinesh

Karumanchi’s and Houston County Health Care Authority’s
motions to dismiss, etc. (Doc. Nos. 10 & 26) are denied
and

plaintiff

McBride’s

medical-malpractice

claims

against them are not dismissed and will proceed in this
case.
DONE, this the 7th day of June, 2013.

/s/ Myron H. Thompson
UNITED STATES DISTRICT JUDGE