Larry Bowles v. Bourbon Cnty., Ky., 21-5012

Background

Shannon Bowles was arrested March 15, 2016, evaluated at a nearby hospital, returned to the Bourbon County jail, and prescribed monitoring for possible drug withdrawal.
Over the next 12 days Bowles repeatedly complained of severe headaches, sinus pressure, nausea, vomiting, and insomnia to jail medical staff (an LPN and APRNs); staff attributed symptoms to sinusitis and drug withdrawal and prescribed symptomatic medications.
On March 27 deputies and medical staff observed acute deterioration; the jail sent Bowles to the hospital after consultation; CT showed a large right temporal mass, he was intubated, transferred, declared brain dead, and died March 29; autopsy showed a large cavitary temporal abscess.
Plaintiffs (estate representatives) sued ACH and individual jail medical and custody staff under 42 U.S.C. § 1983 for constitutionally inadequate medical care, alleging failure to use withdrawal flow sheets, failure to send Bowles earlier to the hospital, and inadequate policies/training.
The district court granted summary judgment for defendants applying the subjective deliberate-indifference standard; the Sixth Circuit affirmed, holding plaintiffs failed to show even objective unreasonableness and therefore could not prevail under plaintiffs’ preferred Kingsley standard.
The panel declined to resolve whether Kingsley’s objective-unreasonableness test extends to pretrial-detainee medical-care claims because plaintiffs’ theory fails even under that standard.

Issues

Issue	Plaintiff's Argument	Defendant's Argument	Held
Does Kingsley’s objective-unreasonableness standard apply to pretrial-detainee inadequate-medical-care claims?	Kingsley should govern because plaintiffs are pretrial detainees and objective test is less onerous.	Kingsley was an excessive-force case and should not be extended to medical-care claims.	Court declined to decide the split; resolved case on merits because plaintiffs fail even under Kingsley’s objective test.
Were individual medical/jail staff objectively unreasonable in treating Bowles?	Staff failed to use flow sheets, missed signs, delayed hospital transport, and miscommunicated symptoms (vomiting, visual changes).	Staff acted reasonably based on information available; at most negligent.	Summary judgment: plaintiffs produced at best negligence; staff conduct not objectively unreasonable.
Was Bowles’s condition a "sufficiently serious" medical need?	Persistent migraine-like headache with vomiting and eventual neurologic collapse was serious.	A bare headache is not necessarily sufficiently serious.	Court assumed the condition could be sufficiently serious for purposes of analysis.
Can ACH be held liable under Monell for policy/training failures?	ACH failed to provide written protocols/flowsheets and adequate training, making harm a predictable result.	No underlying constitutional violation by individuals; county responsible for some policies; ACH trained staff per contract.	Monell claim fails because plaintiffs did not show ACH’s policies caused a constitutional violation beyond negligence.

Key Cases Cited

Kingsley v. Hendrickson, 576 U.S. 389 (U.S. 2015) (pretrial-detainee excessive-force claims require objective-unreasonableness standard)
Estelle v. Gamble, 429 U.S. 97 (U.S. 1976) (Eighth Amendment deliberate indifference to serious medical needs is unconstitutional)
Farmer v. Brennan, 511 U.S. 825 (U.S. 1994) (two-part test for Eighth Amendment deliberate indifference: objective risk and subjective culpability)
Monell v. Dep’t of Social Servs., 436 U.S. 658 (U.S. 1978) (municipal liability for constitutional violations resulting from policy or custom)
Richmond v. Huq, 885 F.3d 928 (6th Cir. 2018) (discussing effect of Kingsley on pretrial-detainee claims and noting uncertainty)
Darnell v. Pineiro, 849 F.3d 17 (2d Cir. 2017) (applying Kingsley’s objective standard to pretrial-detainee inadequate-medical-care claims)
Blackmore v. Kalamazoo County, 390 F.3d 890 (6th Cir. 2004) (defining sufficiently serious medical need standard)
Wilson v. Seiter, 501 U.S. 294 (U.S. 1991) (mental-state requirement for Eighth Amendment claims)
Shadrick v. Hopkins County, 805 F.3d 724 (6th Cir. 2015) (Monell failure-to-train theory and foreseeability of harm)