14 F.4th 585
6th Cir.2021Background
- Tammy Brawner was jailed in Scott County (June 29, 2016); her intake form listed four prescribed medications including three controlled substances (suboxone, clonazepam, gabapentin). The booking officer noted she did not fully comprehend questions.
- Scott County policy: (1) initial nurse physical may be delayed up to 14 days; (2) blanket ban on administering controlled substances unless expressly ordered by the jail doctor; and (3) practice for non-medical booking officers to perform intake screening and place a copy of the form in the nurse’s mailbox.
- Brawner was not given her prescribed medications after booking; she suffered a seizure on July 7 and multiple, escalating seizures the following days, ultimately requiring ICU care and leaving her with severe injuries.
- Brawner sued under 42 U.S.C. § 1983 alleging Fourteenth Amendment violations (inadequate medical care; excessive force/tasing—later abandoned). Individual defendants were dismissed or stipulated away; Scott County remained the sole defendant.
- The district court granted JMOL to Scott County after plaintiff’s case. The Sixth Circuit reversed in part and remanded, holding sufficient evidence for a jury to find municipal liability based on the 14‑day examination policy and the no‑controlled‑substances policy, but affirmed dismissal of other municipal theories.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether County policies (14‑day exam and blanket ban on controlled substances) can support municipal liability for Brawner’s injuries | County policies caused delay/refusal of necessary meds; policies were moving force behind seizures | Any harm resulted from individual errors or negligence in implementation, not from County policy or a recurrent pattern | Reversed in part: evidence sufficient for a jury to find County liable under those two policies; case remanded for trial on those theories |
| Proper mens rea/standard for pretrial‑detainee deliberate‑indifference claims post‑Kingsley | Kingsley requires an objective standard (no subjective awareness element) for pretrial detainees | Farmer’s subjective deliberate‑indifference standard remains controlling; Kingsley limited to excessive‑force claims | Sixth Circuit adopts that Kingsley requires modification: plaintiff must show more than negligence but less than intent—something like reckless disregard (objective/component akin to Castro/Darnell); district court should use that standard on remand (panel split; separate opinion dissents in part) |
| Sufficiency of evidence that Nurse Massengale (or another individual) violated Brawner’s constitutional rights | Nurse knew or should have known risks (intake form, post‑hospital info, experts) and recklessly/ intentionally failed to secure meds or consult doctor | Nurse lacked actual knowledge; followed procedures; monitoring and calls to doctor negate deliberate indifference | The panel concluded there was sufficient evidence for a reasonable jury to find Nurse Massengale violated Brawner’s Fourteenth Amendment right to adequate medical care (supports municipal claim) |
| Other municipal theories (use of non‑medical booking officers, single‑nurse weekday staffing, taser allegation) | These customs/policies contributed to delayed care and an alleged taser during seizures | Insufficient proof these policies caused constitutional harm; evidence at most shows negligence or is too speculative | Affirmed: insufficient evidence to tie these customs/staffing policies (or the taser allegation) to constitutional liability against Scott County |
Key Cases Cited
- Kingsley v. Hendrickson, 576 U.S. 389 (2015) (adopted an objective standard for pretrial‑detainee excessive‑force claims and distinguished prisoner/detainee contexts)
- Farmer v. Brennan, 511 U.S. 825 (1994) (Eighth Amendment deliberate‑indifference requires subjective awareness of substantial risk)
- Monell v. Dep’t of Social Servs., 436 U.S. 658 (1978) (municipal liability under § 1983 requires an official policy or custom causing the constitutional violation)
- Bell v. Wolfish, 441 U.S. 520 (1979) (Due Process protection for pretrial detainees: punishment analysis and objective inquiry into conditions)
- Estelle v. Gamble, 429 U.S. 97 (1976) (constitutional claim for inadequate medical care limited to deliberate indifference, not mere malpractice)
- Bruederle v. Louisville Metro Gov’t, 687 F.3d 771 (6th Cir. 2012) (discussed constitutional concerns about abrupt withdrawal/no‑narcotics policies and causation limits)
- Darnell v. Pineiro, 849 F.3d 17 (2d Cir. 2017) (pre‑Kingsley line: modifies deliberate‑indifference analysis for pretrial detainees toward a recklessness/ objective approach)
- Castro v. County of Los Angeles, 833 F.3d 1060 (9th Cir. 2016) (en banc) (pretrial‑detainee deliberate‑indifference requires proof of intentional or reckless failure to mitigate known or obvious risks)
- Morgan v. Fairfield County, 903 F.3d 553 (6th Cir. 2018) (elements for proving municipal liability: identify policy or custom, connect it to the municipality, and show causation)