Lucas v. Turn Key Health Clinics
58 F.4th 1127
10th Cir.2023Background
- Michelle Caddell was jailed in Tulsa County (Dec 2018–Nov 2019) and repeatedly complained of severe vaginal bleeding, discharge, hip/groin pain, and worsening symptoms.
- Medical testing showed leukocytosis and a vaginal culture with heavy E. coli growth (mid-August); she was reportedly given only Tylenol and later denied additional ibuprofen by Dr. Gary Myers (Sept 3, 2019).
- A nurse referred Caddell to an OB/GYN (Sept 15); Turn Key’s administrator initially denied the referral for verification; an OB/GYN diagnosed suspected invasive cervical cancer on Sept 27; by Oct 30 she was hospitalized and found to have at least stage 3 cervical cancer.
- Plaintiff (Lucas, special administrator) sued under 42 U.S.C. § 1983 for deliberate indifference (Dr. Myers; Monell claims vs. Turn Key and Sheriff Regalado), Equal Protection, and state-law negligence/wrongful death; district court dismissed all claims and found state-law immunity for Dr. Myers.
- The Tenth Circuit (this opinion) reversed the dismissal as to the deliberate-indifference claim against Dr. Myers and reversed the early grant of OGTCA immunity as premature, but affirmed dismissal of municipal Monell and Equal Protection claims; case remanded.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Deliberate indifference (Dr. Myers) — failure-to-treat | Myers ignored and downplayed serious, worsening signs (labs, E. coli, bleeding), provided only Tylenol, denied further meds, and failed to refer → conscious disregard | Myers provided repeated encounters, ordered some testing, and prescribed/authorized OTC pain meds; at most negligence or medical judgment | Reversed: complaint plausibly pleads both failure-to-treat and gatekeeper theories of deliberate indifference sufficient to survive Rule 12(b)(6) |
| Whether presence of some care defeats §1983 claim | Some care (visits, tests, Tylenol) still leaves a plausible claim when care was the functional equivalent of a denial or referral was unreasonably delayed | A complete denial of care is required; providing some treatment forecloses constitutional claim | Court: providing some care does not automatically defeat a claim; inquiry is whether care was functionally equivalent to denial or patently unreasonable |
| Gatekeeper theory (failure to refer) | Myers, aware of worsening signs, failed to refer or seek outside expertise; nurse later made the OB referral based on same facts | Referral/transfer ultimately occurred (by others); Myers was not the gatekeeper or unaware he couldn’t treat the condition | Reversed as to Dr. Myers: complaint plausibly alleges he had a gatekeeper duty and provided the functional equivalent of a denial |
| Monell municipal liability and Equal Protection (Turn Key, Sheriff) | Corporate/jail policies incentivize cost-cutting, under-prescribing, and keeping inmates in-jail → systemic custom causing injury; policies disparately affected female inmates (screening/feminine hygiene) | No sufficiently pleaded custom/policy or causal link between policies and Caddell’s injury; facts show individual conduct by Myers, not a policy-driven practice | Affirmed: complaint fails to plead specific policy/custom facts or causation to support municipal Monell or Equal Protection claims |
| OGTCA immunity for Turn Key / Dr. Myers (state-law claims) | Barrios footnote should not be read as resolving whether private medical contractors and their employees automatically receive OGTCA immunity; premature at dismissal stage | District court relied on Barrios footnote and held healthcare contractor personnel immune | Reversed as premature: court declines to resolve immunity at 12(b)(6); issue reserved for summary judgment with a developed factual record |
Key Cases Cited
- Sealock v. Colorado, 218 F.3d 1205 (10th Cir. 2000) (deliberate-indifference framed as failure-to-treat or gatekeeper theories)
- Farmer v. Brennan, 511 U.S. 825 (1994) (subjective standard: official must know of and disregard excessive risk)
- Oxendine v. Kaplan, 241 F.3d 1272 (10th Cir. 2001) (some care can still support deliberate indifference where specialist referral is unreasonably delayed)
- Self v. Crum, 439 F.3d 1227 (10th Cir. 2006) (medical judgment vs. patently unreasonable treatment; circumstantial evidence of awareness)
- Mata v. Saiz, 427 F.3d 745 (10th Cir. 2005) (gatekeeper theory and unlawful delays; even brief delays can be unconstitutional)
- Estelle v. Gamble, 429 U.S. 97 (1976) (medical malpractice not necessarily an Eighth Amendment violation)
- Monell v. Department of Social Services, 436 U.S. 658 (1978) (municipal liability requires policy/custom and causation)
- Ashcroft v. Iqbal, 556 U.S. 662 (2009) (plausibility pleading standard)
- Barrios v. Haskell County Public Facilities Authority, 432 P.3d 233 (Okla. 2018) (Oklahoma Supreme Court footnote assumed healthcare-contractor employees fell under OGTCA; court declined to treat that assumption as dispositive at motion-to-dismiss stage)