Jemme J. Jenkins, Individually, and Administrator of the Estate of Jimmie Lee Alexander, Sr. v. Corizon Health Inc. et al

Filing 233

ORDER granting 123 Motion for Summary Judgment by Chatham County Commissioners. Signed by Judge William T. Moore, Jr. on 08/27/2020. (JH)

IN THE UNITED STATES DISTRICT COURT FOR
THE SOUTHERN DISTRICT OF GEORGIA
SAVANNAH DIVISION

JEMME J. JENKINS, Individually,
and JULIANNE GLISSON,
Administrator of the Estate of

Jimmie L. Alexander, Sr.,

Plaintiffs,
CASE NO. CV418-099

V.

CORIZON HEALTH INC., a Delaware

Corporation; GUY AUGUSTIN, M.D.;
VICTORIA NEILSER, LPN; KEVIN

TODD, Corporal; MARK DAMBACH,
LPN; CARL MILTON, Sergeant;
WANDA WILLIAMS, Lieutenant;
DESMOND BRYANT, Corporal;
CHATHAM COUNTY COMMISSIONERS;

JOHN WILCHER, Sheriff of Chatham
County; and JOHN DOES 1-5;
Defendants.

ORDER

Before the Court is Defendants Chatham County Commissioners'

(^'County Defendants") Motion for Summary Judgment. {Doc. 123.) For
the

following

reasons.

County

Defendants'

motion

(Doc.

123)

is

GRANTED.

BACKGROUND

I.

THE INCIDENT ON MAY 22-24, 2016

This case arises out of the incarceration and subsequent death
of Jimmie Alexander, Sr. ('"Alexander") in 2016. (Doc. 1.) Alexander

was a pretrial detainee at Chatham County Detention Center ("CCDC").
(Doc. 86, Attach. 2.) At the time of Alexander's detention. Defendant

Corizon

Health,

Inc.

('"Corizon")

provided

medical

services

to

detainees at CCDC pursuant to a contract with Chatham County. (Doc.
87, Attach. 1.) At all relevant times. Defendant Dr. Guy Augustin
was the acting onsite medical director employed by Corizon. (Doc.
156 at 94.) Defendant Corizon also employed Defendant Mark Dambach
C'Dambach"),

a

licensed

practical

nurse

C'LPN"),

and

Defendant

Victoria Neisler C'Neisler"), also an LPN. (Doc. 150 at 17-18; Doc.

154 at 33.) Jimmie Alexander, Sr. ('"Alexander") was booked into CCDC

as a pretrial detainee on April 27, 2016. (Doc. 86, Attach. 2 at 1.)
Alexander was sixty years of age at the time of his intake. (Id.)
Alexander reported during the intake screening process that his
medical history included hypertension, a smoking history of over

twenty years, and a transient ischemic attack ("TIA") that occurred
in March 2016. (Doc. 74, Attach. 9 at 5-9.)

On May 22, 2016, at approximately 8:30 p.m., Alexander began to

complain about pain in his right hip and leg. (Doc. 97, Attach. 7 at
11; Doc. 49 at 137.) At approximately 8:47 p.m. on May 22, 2016, a
Signal 55

was

called for

Alexander.^

(Doc.

85

at 65.)

Dambach

responded to the call and evaluated Alexander between 9:02 p.m. and
9:13 p.m. (Doc. 150 at 105-10.) During this examination, Dambach

understood Alexander's complaint to be that he began experiencing
right leg pain suddenly and found that Alexander had a weak, thready

1 A "Signal 55" is a code that means that an inmate needs medical
attention. (Doc. 85 at 29.)

pedal pulse in his right foot. (Id. at 105-06.) Alexander reported
to Dambach that the pain felt like '"his leg was broken, his hip was
out of the socket." (Id. at 109.) Dambach checked Alexander's vitals

and noted that his blood pressure was elevated at 188 over 122. (Id.
at 107.) Before leaving Alexander's cell, Dambach told Alexander
that he was going to relay this information to the doctor and then
be back once he received orders from the doctor and that he would

bring any medications that been ordered. (Id. at 110-11.)

Dambach

called

Dr. Augustin

informed

Augustin

of

Alexander's

reported

right leg and

hip

after

evaluating Alexander

elevated

blood

pressure,

pain, and Alexander's

known

and
the

medical

history. (Doc. 150 at 111.) Augustin prescribed Clonodine 0.1 mg,

for

reducing

blood

pressure,

Novasc

10

mg,

for

reducing

blood

pressure, and Naproxyn 500 mg, for the pain. (Id. at 111-112; Doc.

156 at 159-160.) Around 9:30 p.m., Alexander used a plastic chair
while walking to the wing officer's desk in Unit 6D, the unit he was
housed in, and was dragging his right leg. (Doc. 96 at
Doc.

145

at

SISI

30-31.)

At

approximately

9:45

p.m.,

30-31;
Dambach

administered the above medications to Alexander. (Doc. 150 at 118.)

Dambach did not examine Alexander when he gave him the medications.

(Id. at 117.) Around 11:15 p.m., Alexander used a plastic chair to
travel to the restroom and at 11:30 p.m., several inmates carried
Alexander
11 36-37.)

back to

his

pod.

(Doc.

96 at

SISI

36-37;

Doc.

145 at

Around 11:40 p.m., Alexander crawled out into the middle of
Unit 6D floor and vomited as he crawled out. (Doc. 96 at

Doc. 145 at

38-39;

38-39.) At 11:39 p.m., Defendant Todd called a 10-78

code which means that the officer needs assistance, but is not in

any danger.

(Doc.

85 at

29,

113.)

Deputies,

including

Sergeant

Milton, arrived in Unit 6D in response to the 10-78 and the 10-78

turned into a Signal 55. (Id. at 117; Doc. 91 at 76-77.) Dambach
responded to the Signal 55 and arrived in Unit 6D around 11:48 p.m.

and found Alexander lying on the floor next to a small amount of
vomit. (Doc. 150 at 131.) Dambach proceeded to check Alexander's
vitals, but did not otherwise check Alexander's right leg. (Id.)
Dambach

went

to

the

Medical

Unit

and

called

Augustin

at

approximately midnight of May 22. (Id. at 133.) Augustin and Dambach
agreed that Alexander should be sent to infirmary, however, the male
beds

in

the

infirmary

were

reportedly

full.

(Id.

at

133-34.)

Alexander was placed into a wheelchair and taken to Receiving and
Discharge (^'R&D") for observation during the night. (Id.; Doc. 91 at

50-51.) Dambach examined Alexander's right foot pulse before placing
him in the R&D cell, but did not document that he did so. (Doc. 150

at 151-52.) Alexander was placed in R&D cell #8 at 12:21 a.m. on
Monday, May 23, 2016. (Id. at 151.)

Augustin came to CCDC at 7:30 a.m. on Monday, May 23, 2016 and
spoke

about

Alexander

with

other

medical

providers

at

morning

conference. (Doc. 156 at 133-34.) Augustin, however, did not examine

Alexander that morning and subsequently left CCDC around 8:30 a.m.
to find a dentist for himself. (Id. at 132-33.) Alexander was placed

on Augustin's "sick call list'' to be seen by Augustin. (Doc. 156 at
134.) Also on the morning of Monday, May 23, 2016, around 7:00 a.m.,

Victoria Neisler came on duty in CCDCs R&D area for the day shift,
relieving Dambach. (Doc. 154 at 127.) Dambach told Niesler about
Alexander's leg pain. (Doc. 150 at 176, 178; Doc. 154 at 130.)
Neisler

visited

Alexander

standing in the cell.

to

check

on

him

and

(Doc. 154 at 138-140.)

saw

that

he

was

During that time,

Neisler took Alexander's blood pressure but did not otherwise take
any other vital signs or examine Alexander's right leg or foot. (Id.)

Augustin returned to CCDC later on May 23, 2016 and examined
Alexander at approximately 3:00 p.m. on Monday, May 23, 2016. (Doc.
156 at 162, 196, 224.) During his examination, Augustin noted the

absence of a pulse on the top of the foot and that Alexander's right
lower

limb

examination,

was

cool

to

Augustin

the

told

touch.

(Id.

Alexander

that

at
he

163.)
was

During
going

to

this
the

hospital because Augustin believed he had some type of vascular issue
due

to

the

coolness

in

his limb.

(Id.

at 165-66.) Alexander

was

placed into a wheelchair and moved to a holding room in the Medical
Unit around 3:11 p.m. (Id. at 231-32.) Augustin ordered Alexander to
be taken to the emergency room. (Id. at 228-29.) Alexander was to be
transported by car to the hospital. (Doc. 92 at 77-78; Doc. 89 at
68.)

The

CCDC

watch

commander.

Defendant

Lieutenant

Williams,

received the instruction to transport Alexander to the hospital at

3:16 p.m.2

(Doc. 92 at 77, 80.) Defendant Williams testified that

at roughly 3:21 p.m., she contacted Corporal Kelly-James but she did
not take Alexander because she complained of not having her lunch

break and her shift ending at 4:00 p.m. (Id. at 79, 89.) Defendant
Williams

testified

that

she

then

contacted

Defendant

Bryant

roughly 3:30 p.m. to transport Alexander and expected

at

Defendant

Bryant to be ready to leave with Alexander by 4:00 p.m. (Id. at 90.)
Internal records show an entry dated May 23, 2016 at 3:47 p.m. with
an event time of 3:16 p.m. that reads: ^^The doctor recommends that
detainee Jimmy Alexander 6D be transported to MMC via car for an
evaluation. Cpl. Kelly-James assigned to complete the detail." (Doc.
92, Attach. 2 at 19.) Thus, at the time that Defendant Williams

completed

the

entry,

3:47

p.m.,

the

log

only

reflects

that

Kelly-James had been contacted. Corporal Bryant, however, testified
that he did not receive a call to transport Alexander until 4:40

p.m. (Doc. 88 at 17.) Defendant Bryant further testified that he and
Alexander
Memorial

left

CCDC

Health

at

approximately

University

5:08

Medical Center

p.m.

and

arrived

('"Memorial")

at

emergency

room around 5:42 p.m. (Id. at 40.) Memorial's records show that

2 Corporal Addie

Bailey

(nee

Cochran) testified

that the

Watch

Commander, Defendant Williams, was notified at 3:18 p.m. (Doc. 89 at
68.)

Alexander arrived at 5:38 p.m. on May 23, 2016 and was admitted at
5:42 p.m. (Doc. 94, Attach. 1 at 2.)

When Alexander presented at Memorial, his right leg was cold,
pulseless, insensate and without motor function. (Id. at 3, 6-7.)

Memorial emergency room doctors consulted with vascular medicine
doctors. (Id. at 7.) At 5:59 p.m. on May 23, Alexander had blood
drawn for various lab panels. (Doc. 77, Attach. 1 at 87.) At 7:07
p.m. on May 23, 2016, Alexander's potassium levels were recorded at
5.1

mmol/L.

(Id.)

Dr.

Bhandari,

a

vascular

interventional

radiologist, reviewed the CT angiogram of Alexander's right leg and
found an extensive blood clot. (Doc. 77 at 24-27.)

Dr. Bhandari

determined that surgery would be needed. (Id. at 27-28.) Dr. Avino,
a vascular surgeon, began a thrombectomy on Alexander at 10:05 p.m.
on May 23, 2016. (Doc. 94, Attach. 1 at 28.) Anesthesia was concluded
at 11:52 p.m. on May 23, 2016 and Alexander was transferred from the
operating room to the post-anesthesia care unit ('"PACU") to recover
on May 24, 2016 at 12:00 a.m. (Id.)

Alexander had blood specimens drawn at 2:05 a.m. on May 24,
2016.

(Doc.

77,

Attach.

1

at

88-89.)

Alexander's

PACU

treatment

concluded at 2:30 a.m. (Id. at 28.) The various lab tests performed
on Alexander resulted at different times. The CBC with differential

lab resulted at 2:37 a.m., the Protime-INR lab resulted at 2:51 a.m.,

and the PTT lab resulted at 2:51 a.m. on May 24, 2016. (Id. at

89-90.) The basic metabolic panel, which includes a value for the

patient's potassium level, resulted at 4:36 a.m. on May 24, 2016.

(Id. at 91.) Alexander's potassium level was recorded at 7.3 mmol/L
and reported by lab staff at 4:37 a.m. (Id.) Dr. Moon, the chief
resident working that night, was informed of Alexander's potassium
level, and he and his team went to the PACU and found Alexander in
cardiac arrest. (Doc. 77, Attach. 1 at 12-13, 18.) Alexander could

not be revived and was declared dead by Dr. Moon on May 24, 2016 at

approximately 5:13 a.m. (Doc. 77, Attach. 1 at 18; Doc. 90, Attach.
3 at 1.)

Alexander's autopsy was performed by the Georgia Bureau of
Investigations ("GBI") medical examiner. Dr. J. Upshaw Downs. (Doc.

90, Attach. 3.) Dr. Downs opined that Alexander's cause of death was
the result of ^^generalized arteriosclerosis which manifests as right
lower extremity ischemia, status postoperative with subsequent acute

onset hyperkalemia." (Id. at 8.) Dr. Downs found that Alexander's
excessive potassium and released toxins during reperfusion postsurgery contributed to Alexander's cardiac arrest and death.
II.

CORIZON'S HEALTHCARE CONTRACT

In

2010,

Chatham

County,

by

and

through

the

Board

of

Commissioners of Chatham County, Georgia, entered into a contract
with

Prison

Health

Services,

Inc.

for

the

provision

of

inmate

healthcare services. (Doc. 168, Attach. 5 at 2.) The contract was

annual, but had four renewals with an expiration date of February

26, 2015. (Id.) Around July 2011, Prison Health Services, Inc.'s

name changed to Corizon. (Doc. 168 at 38-39.) The annual cost under
the contract for 2010 was $5,399,000.00. (Doc. 168, Attach. 5 at
26.) In 2011, Chatham County paid $5,584,224, in 2012 the amount was

$5,774,088, and in 2013, the amount paid was $5,774,088. (Doc. 167
at 16-17; Doc. 167, Attach. 2 at 1.) Subsequently, Corizon and

Chatham County entered into a contract on January 17, 2014 in the
amount of $5,074,224. (Doc. 87, Attach. 1; Doc. 167, Attach. 2 at

1.) Linda Cramer, a designated corporate representative for Chatham

County, testified that the compensation was $5,070,224 for both 2014
and 2015. (Doc. 167 at 17.)

Pursuant to the contract, Corizon had assumed all medical care,

including psychiatric but with the exclusion of psychologist, for
all inmates at CCDC. (Doc. 87, Attach. 1 at 14.) Corizon was to staff

nurses in various parts of CCDC as follows: (1) in the Medical Unit
24 hours a day, 7 days a week, (2) in the R&D area 24 hours a day,
7 days a week, (3) each of the housing units for 8 hours, 5 days a
week and (4) in the infirmary 24 hours a day, 7 days a week. (Id. at
14-15.)

In 2015, Chatham County expressed a concern about Corizon's
staffing levels and felt that there should have been additional
registered nurses (^^RNs") in the facility at any given time. (Doc.
166 at 38-39.) By e-mail dated September 18, 2015, Scott Bowers,
with

Corizon,

emailed

Lee

Smith

and

Micheal

Kaigler

at

Chatham

County. (Doc. 93, Attach. 9 at 3.) In that e-mail. Bowers summarized

a meeting between

representatives of Corizon and Chatham County

regarding care at CCDC. Specifically, Bowers mentioned that ''there
was a question regarding our staffing Licensed Practical Nurses
(LPNs) at intake to conduct health screenings. We recognize your
consultants have recommended Registered Nurses (RNs) at intake, and
we can do that." (Id. at 4 (emphasis in original).) Bowers then

states that the cost of adding an RN for 12 hours per night would be
$197,172. (Id.) Bowers further stated that "when the question of

staffing an RN at night was first raised, my team did not believe it
to be incumbent upon Corizon Health to absorb this cost because they
are confident that we have structured a sound inmate medical program
. . . ." and offered to share the cost of increased nursing staff.

(Id.) An increase in RN staffing was never adopted. (Doc. 93 at 110.)
At the time of Alexander's incarceration and subsequent death,

Chatham

County

was

in

the

process

of

soliciting

a

new

inmate

healthcare provider through a request for proposal ("RFP"). (Doc.
168 at 28-29.) The contract was awarded to Correct Health in July
2016. (Id. at 29.) Correct Health's contract for 2016 was in the
amount of $6,973,725. (Doc. 167 at 17.)
III.

PROCEDURAL HISTORY

After his death, Alexander's son, Jemme Jenkins, brought suit

in both his individual and representative capacity for the benefit
of, and on behalf of, the Estate of Jimmie Lee Alexander, Sr. in the

State Court of Chatham County, Georgia. (Doc. 1, Attach. 1 at 2-17.)

10

After amending his complaint to add a claim under 42 U.S.C. § 1983
for

the

alleged

deliberate

indifference

to

Alexander's

needs, the action was removed to this Court. (Doc. 1 at

medical
1-2.) On

May 24, 2018, Plaintiff Jenkins filed a second amended complaint
adding Julianne Glisson, in her capacity as Administrator for the
Estate

of

Jimmie

Lee

Alexander,

Sr.,

as

plaintiff.

(Doc.

15.)

Plaintiffs subsequently filed a third amended complaint. (Doc. 26,
Attach. 1.)

In

their

following

third

claims:

amended

(1)

a

complaint.

professional

Plaintiffs

negligence

allege

claim

the

against

Defendants Corizon, Augustin, Dambach, and Neisler (collectively,
the ^'Corizon Defendants"), (2) a negligence claim against Corizon

Defendants, (3) a negligence claim against Defendants Wilcher, Todd,
Milton,

Williams,

Defendants"),

(4)

and
a

Bryant

claim

(collectively,

against

Defendant

the
Chatham

"Sheriff
County

Commissioners alleging that they are liable for failing to correct

inadequate funding to the Chatham County Sheriff's Office, (5) a
claim of deliberate

indifference

against all

Defendants,

pursuant

42

to

intentional

U.S.C.

infliction

(6) a
§
of

1983

under

the

Georgia

Constitution

claim of deliberate indifference
against

emotional

all

distress

Defendants,
claim

(7)

against

an
all

Defendants, (8) a claim for punitive damages against all Defendants,
and (9) a claim for breach of sheriff and deputy bonds. (Id. at

11

11-24.) County Defendants now move for summary judgment on the claims
against them. (Doc. 123.)
STANDAEU3 OF REVIEW

According to Fed. R. Civ. P. 56(a), 'Ma] party may move for
summary judgment, identifying each claim or defense—or the part of
each claim of defense—on which summary judgment is sought." Such a
motion must be granted "if the movant shows that there is no genuine

dispute as to any material fact and the movant is entitled to
judgment as a matter of law." Id. The "purpose of summary judgment
is to 'pierce the pleadings and to assess the proof in order to see

whether there is a genuine need for trial.' "

Matsushita Elec.

Indus. Co. V. Zenith Radio Corp., 475 U.S. 574, 587, 106 S. Ct. 1348,
1356, 89 L. Ed. 2d 538 (1986) (quoting Fed. R. Civ. P. 56 advisory

committee notes). Summary judgment is appropriate when the nonmoving
party "fails to make a showing sufficient to establish the existence
of an element essential to that party's case, and on which that party
will bear the burden of proof at trial." Celotex Corp. v. Catrett,
477 U.S. 317, 322, 106 S. Ct. 2548, 2552, 91 L. Ed. 2d 265 (1986).

The

substantive

law

governing

the

action

determines

whether

an

element is essential. DeLong Equip. Co. v. Wash. Mills Abrasive Co.,
887 F.2d 1499, 1505 (11th Cir. 1989).

As the Supreme Court explained:

[A] party seeking summary judgment always bears the
initial responsibility of informing the district court of
the basis for its motion, and identifying those portions
of the pleadings, depositions, answers to interrogatories,

12

and admissions on file, together with the affidavits, if
any, which it believes demonstrate the absence of a genuine
issue of material fact.

Celotex, 477 U.S. at 323, 106 S. Ct. at 2553. The burden then shifts

to the nonmoving party to establish, by going beyond the pleadings,
that there is a genuine issue concerning facts material to its case.
Clark V. Coats & Clark, Inc., 929 F.2d 604, 608 (11th Cir. 1991).
The

Court

must

inferences

review

the

arising from

evidence

it in

and

all

reasonable

factual

the light most favorable

to

the

nonmoving party. Matsushita, 475 U.S. at 587-88, 106 S. Ct. at 1356.
However, the nonmoving party ^'must do more than simply show that

there is some metaphysical doubt as to the material facts." Id., 475
U.S. at 586, 106 S. Ct. at 1356.

A mere ^^scintilla" of evidence, or

simply conclusory allegations, will not suffice. See, e.g., Tidwell
V. Carter Prods., 135 F.3d 1422, 1425 (11th Cir. 1998). Nevertheless,

where a reasonable fact finder may "draw more than one inference
from

the

material

facts,
fact,

and
then

that
the

inference
Court

creates

should

a

refuse

genuine
to

grant

issue

of

summary

judgment." Barfield v. Brierton, 883 F.2d 923, 933-34 (11th Cir.
1989).
ANALYSIS

I.

COUNTY DEFENDANTS^

IMMUNITY FROM SUIT

County Defendants first argue that all claims brought against
them are barred by the doctrine of sovereign immunity. (Doc. 124 at
2-5.) Plaintiffs have brought state law claims and a federal § 1983

13

claim against County Defendants. The Court finds that the state law
claims against County Defendants are due to be dismissed.

^^In Georgia, ^sovereign immunity extends to the state and all
of its departments and agencies.' " Carter v. Butts Cty., Ga., 821
F.3d 1310, 1323 (llth Cir. 2016) (quoting Ga. Const, art. I § 2,
SI

IX; Gilbert

v.

Richardson,. 264

Ga.

744,

452

S.E.2d

476,

479

(1994)). Sovereign immunity extends to counties as well unless waived
by the General Assembly. Id.; see also Presnell v. Paulding Cty.,
Ga., 454 F. App'x 763, 769 (llth Cir. 2011). Plaintiffs bear the
burden to

demonstrate

that sovereign

immunity

has

been

waived.

Carter, 821 F.3d at 1323.

In their response. Plaintiffs argue that a local government

does

not

enjoy

violations.

sovereign

(Doc.

186

at

immunity
5.)

The

from
Court

federal
finds

constitutional

these

statements

insufficient to demonstrate a waiver of sovereign immunity in this
case. Plaintiffs have failed to identify a specific waiver of the

state's sovereign immunity and focuses more generally on their
ability to bring their federal § 1983 claim. Counties and sheriffs

enjoy

sovereign

immunity

for

tort

claims

under

the

Georgia

Constitution, including claims related to the provision of medical

care in jails. Temple v. Mclntosh Cty., Ga., No. 2:18-CV-91, 2019 WL
287482, at *7 (S.D. Ga. Jan. 22, 2019); Tattnall Cty. v. Armstrong,

333 Ga. App. 46, 52, 775 S.E.2d 573, 578 (Ga. Ct. App. 2015),
overruled on other grounds by Rivera v. Washington, 298 Ga. 770, 784

14

S.E.2d 775 (2016). The Court, therefore, finds that County Defendants

are entitled to summary judgment on Plaintiffs' state law claims.

County Defendants' motion for summary judgment on this basis is
GRANTED.

As to County Defendants' argument that Plaintiffs' § 1983 claim
is also barred by sovereign immunity, the Court finds that this
argument fails. First, it is not clear to this Court the exact

parameters of Plaintiffs' § 1983 claims against County Defendants.
In their third amended complaint. Plaintiffs allege a broad § 1983
claim against all Defendants for "exhibiting deliberate indifference
to Alexander's federal constitutional rights and by denying and

delaying adequate medical care to him, including emergency care when
it was obviously needed." (Doc. 26, Attach. 1 at 21.) However, in
count four. Plaintiffs specifically allege a claim against County

Defendants for their failure to adequately fund CCDC and contend
that the "failure to correct this known inadequacy was widespread,

persistent

and

established

a

custom

or

policy

that

caused

a

constitutional violation of the rights of Alexander . . . ." (Id. at

19.) Similarly, in their response to County Defendants' motion for
summary judgment. Plaintiffs focus on the alleged understaffing of

CCDC as the policy by which County Defendants are liable under 42
U.S.C. § 1983. (Doc. 186 at 7.) Reviewing Plaintiffs' third amended

complaint as a whole, the Court finds that Plaintiffs' pursue a
§ 1983 claim against County Defendants on the basis of their alleged

15

unconstitutional policy of understaffing by failing to adequately
fund CCDC.

The Court finds that, to the extent County Defendants contend

that Plaintiffs' § 1983 claim is also barred by sovereign immunity,

this argument fails. Counties (and other local government entities)
are ^"persons" within the scope of § 1983 and may be subject to
liability. McDowell v. Brown, 392 F.3d 1283, 1289 (11th Cir. 2004).
County Defendants argue that, pursuant to Turquitt v. Jefferson Cty.,
Ala., 137 F.3d 1285, 1292 (11th Cir. 1998), a county is "sovereignly
immune from claims brought for causes of actions arising out of the
county's jail." (Doc. 124 at 3.) While there are some circumstances

in which Turquitt may bar actions against counties, the Court finds
County Defendants' reading in this case too expansive.
In Turquitt, the Eleventh Circuit held that a local government

"must have power in an area in order to be held liable for an
official's acts in that area." 137 F.3d at 1292. The Eleventh Circuit

held that the defendant county had no liability because it had no

power over the administration or operation of the jail and that its
authority extended only to "maintaining the jail's physical plant
and providing operational funding." Id. at 1291. Therefore, the
Eleventh

Circuit

found

that,

as

the

sheriff

could

not

be

a

"policymaker" for the defendant county, the county could not be
liable

on

the

basis

of

the

sheriff's

actions.

Id.

at

1292.

The

situation presented here is not the same as the one in Turquitt. The

16

Eleventh Circuit noted in Turquitt that the complaint did not ''relate

to the provision of such necessities, nor does it allude to any
failure on the County's part to appropriate adequate funds." 137
F.Sd at 1290. As stated above, it does not appear that Plaintiffs

are pursuing a § 1983 claim against County Defendants for the actions
of the Sheriff Defendants, but instead contend that County Defendants

were

deliberately

indifferent

to

Alexander's

medical

needs

by

failing to adequately fund and staff the jail to provide medical
care. Turquitt stands for the principle that a local government may

only be held liable pursuant to § 1983 for actions of those whom the
local government has authority over and for injuries that it caused
itself. 137 F.3d at 1290.

In Georgia, counties are charged by the General Assembly with

funding the provision of medical care to inmates. Lake v. Skelton,
840

F.3d

1334,

1341

(11th

Cir.

2016)

(interpreting

O.C.G.A.

§ 42-5-2 and finding that the code section imposes "two separate

duties: the county must fund the provision of medical care, and the
sheriff must select an appropriate provider and ensure that inmates
receive care when necessary."). Therefore, Plaintiffs can maintain
their § 1983 claim based on County Defendants' alleged inadequate

funding. See, e.g.. Marsh v. Butler Cty., Ala., 268 F.3d 1014, 1027
(11th Cir. 2001) (en banc) (finding that, as the defendant county

was charged with erecting and maintaining jails under Alabama law,
the plaintiffs could maintain

an

17

Eighth Amendment claim on the

contention

that

the

failure

to

maintain

the

jail

constituted

deliberate indifference), abrogated on other grounds by Bell Atl.
Corp. V. Twombly, 550 U.S. 544, 127 S. Ct. 1955, 167 L. Ed. 2d 929

(2007); Gaines v. Choctaw Cty. Comm'n, 242 F. Supp. 2d 1153, 1163

(S.D. Ala. 2003) (discussing Turquitt and finding that the plaintiffs
had stated a claim under § 1983 against the defendant county for

failing to provide funding to adequately staff the medical care at

the jail). Thus, the Court denies County Defendants' motion to the
extent that it argues Plaintiffs' § 1983 claim is barred by sovereign
immunity.
II.

PLAINTIFFS'

42 U.S.C. § 1983 CLAIM

AGAINST

COUNTY

DEFENDANTS

FAILS

County Defendants also argue that Plaintiffs' § 1983 claim
against them fails because Plaintiffs cannot prove that they were
indifferent to the medical needs of Alexander either by failing to

fund the Sheriff or by ignoring a warning so clear that a reasonable
person would know harm was imminent. (Doc. 124 at 8.) In response.

Plaintiffs

argue

that

County

Defendants

failed

to

provide

the

necessary funding for a nighttime R&D nurse, knew that the additional
staffing was needed, and that, without additional funding, inmates
would not be receiving adequate healthcare. (Doc. 186 at 6-7.) The
Court finds that Plaintiffs' § 1983 claim against County Defendants
fails.

To impose § 1983 liability on a municipality, a plaintiff must
show: ^'(1) that his constitutional rights were violated; (2) that

18

the municipality had a custom or policy that constituted deliberate
indifference to that constitutional right; and (3) that the policy
or

custom

caused

the

violation." McDowell,

392

F.3d

at

1289.

A

municipality may be liable under § 1983 only where "the deprivation
at issue was undertaken pursuant to city ^custom' or ^policy,' and
not simply on the basis of respondeat superior." Brown v. City of
Fort Lauderdale, 923 F.2d 1474, 1479 (11th Cir. 1991). To prove

§ 1983 liability against a municipality based on custom, "a plaintiff
must establish a widespread practice that, although not authorized

by written law or express municipal policy, is so permanent and well
settled as to constitute a custom or usage with the force of law."

Id. at 1481 (internal quotation marks and citation omitted). Thus,

a longstanding and widespread practice "is deemed authorized by the
policymaking officials because they must have known about it but
failed to stop it." Id. To subject

Defendant Chatham County to

liability under § 1983, Plaintiffs "must show that the constitutional
violation

occurred

as

a

result

of

a

county

policy." Cagle

v.

Sutherland, 334 F.3d 980, 986 (11th Cir. 2003).

In

this

case.

Plaintiffs

argue

that

County

Defendants'

"decision not to fully fund staffing at CCDC was a policy decision."
(Doc. 186 at 7.) Plaintiffs contend that "a pattern of underfunding

is not necessary because the knowledge is shown by direct evidence
of actual knowledge in the communications and [sic] between [County

19

Defendants] and Corizon. (Id. at 9.) This misstates the law and the
evidence.

First, contrary to Plaintiffs' contention. Plaintiffs must show
that County Defendants had a policy of understaffing. To demonstrate

a policy or custom, "it is generally necessary to show a persistent
and wide-spread practice." McDowell, 392 F.Sd at 1290. Plaintiffs
have failed to meet this burden. Plaintiffs do not allege other

instances of underfunding inmate medical care and in fact acknowledge

in their response brief that County Defendants acted on a prior
request to fund two mental health professionals in April 2014. (Doc.
186

at

8.)

Plaintiffs

have

cited

to

no

evidence

that

County

Defendants habitually underfunded inmate medical care or that they

had a practice of denying requests for additional funds. Plaintiffs
cannot rest on this single incident of County Defendants not funding
an RN. See Craig v. Floyd Cty., Ga., 643 F.3d 1306, 1311 (11th Cir.

2011) (finding that § 1983 liability against municipalities cannot

rely

on

single

incident

of

alleged

unconstitutional

activity);

McDowell, 392 F.3d at 1290-91 (finding that, although the plaintiff

provided evidence that the jail had staffing problems, plaintiff
could not produce evidence that the understaffing contributed to or
exacerbated an inmate's medical condition and, therefore, there was

no evidence of a widespread or persistent policy).
Second, Plaintiffs must establish that the action taken, here

the failure to fund a nighttime RN at the R&D area, was " ^taken

20

with the

requisite degree of culpability . . . with deliberate

indifference to its known or obvious consequences.' " McDowell, 392

F.3d at 1283 (quoting Davis ex rel. Doe v. Dekalb County Sch. Dist.,
233 F.3d 1367, 1375-76 (11th Cir. 2000)). Plaintiffs cannot rely on

a generalized policy of understaffing. Id. There is no evidence that

County Defendants knew that the failure to staff a nighttime RN in
R&D would create a substantial risk of serious harm to the inmates

at CCDC or that the '"known or obvious consequence" of not staffing

a nighttime RN at R&D would result in an inmate not receiving
infirmary level care due to the unavailability of the infirmary.
Plaintiffs seem to rely on the fact that County Defendants were the

ones

requesting

a

nighttime

RN

at

R&D

and

that the "need

for

additional funding was obvious and had been expressly recognized by
[Defendant Chatham County]." (Doc. 186 at 7.) However, contrary to

Plaintiffs' assertion, there is no clear evidence of exactly why

County Defendants raised the issue of staffing a nighttime RN.

In an e-mail dated September 18, 2015, Scott Bowers, with
Corizon, emailed Lee Smith and Micheal Kaigler at Chatham County and

stated that "there was a question regarding our staffing Licensed
Practical Nurses (LPNs) at intake to conduct health screenings. We

recognize your consultants have recommended Registered Nurses (RNs)
at intake, and we can do that." (Doc. 93, Attach. 9 at 3-4.) Thus,

according to this source. County Defendants wanted an RN to conduct
health

screenings.

However,

Virginia

21

O'Neill,

the

corporate

representative

for

Defendant

Corizon,

testified

that

County

Defendants wanted a nighttime RN because it was a recommendation
from the accrediting body. (Doc. 110 at 107.) Neither of these
statements demonstrate that County Defendants were aware that the
alleged

constitutional

violation

was

a

""highly

predictable

consequence" of their failure to fund a nighttime RN in the R&D area
or that County Defendants disregarded a risk of serious harm. See
McDowell/

392 F.3d at 1291 (finding that the plaintiff could not

show facts that demonstrated that a member of Board believed that

their budget decisions would cause an inmate not to receive timely
medical care; Cagle, 334 F.3d at 988 (finding that the defendant

county's decision to fund no additional nighttime watcher was not

deliberately indifferent to a substantial likelihood of detainee
suicide because there was no evidence to show that the county was

truly aware that prisoners were likely to attempt suicide). The Court

finds that County Defendants' motion for summary judgment is due to
be granted.
III. PUNITIVE DAMAGES

Because

this

Court

has

granted

summary

judgment

to

County

Defendants on all of Plaintiffs' claims against them, any derivative

claims for punitive damages must be dismissed. See Butler v. Georgia
Dep't of Corr., No. 6:18-CV-170, 2018 WL 6729647, at *7 (S.D. Ga.

Dec. 21, 2018), appeal dismissed. No. 19-10249-AA, 2019 WL 1858369
(11th Cir. Feb. 28, 2019); Lewis v. Meredith Corp., 293 Ga. App.

22

747, 750, 667 S.E.2d 716, 719 {Ga. Ct. App. 2008) ("Under Georgia
law, a plaintiff cannot recover punitive damages when the underlying
tort claim fails.").
CONCLUSION

For

the

foregoing

reasons.

County

Defendants'

Motion

Summary Judgment (Doc. 123) is GRANTED.
SO ORDERED this

of August 2020.

WILLIAM T. MOORE, JR.
UNITED STATES DISTRICT

SOUTHERN

23

COURT

DISTRICT OF GEORGIA

for