Plaintiff, Tjymas Blackmore, appeals the district court’s final order dismissing his claims under 42 U.S.C. § 1983 for violations of his civil rights by Defendants, Kalamazoo County, Kalamazoo County Sheriff Thomas N. Edmonds, in his official capacity (collectively “the County”), and twenty employees of the Kalamazoo County Sheriffs Department in their individual capacities (“the Officers”). 1 Blackmore asserted claims under the Eighth and Fourteenth Amendments against the County and its officers for their failure to provide prompt medical treatment for his serious medical condition, appendicitis, for over two days while Blackmore was detained in the Kalamazoo County jail.
The district court denied Blackmore’s motion for summary judgment, but granted Defendants’ motion for summary judgment on Blackmore’s claims. The district court concluded that under
Napier v. Madison County,
I. BACKGROUND
Members of the Kalamazoo County Sheriffs Department arrested Blackmore at approximately 3:30 a.m. on May 27, 2000 for driving on a suspended license. The Officers then transported Blackmore to the Kalamazoo County Jail, booked him and placed him in a cell at approximately 5:25 a.m. Within an hour of his arrival, Blackmore began experiencing abdominal pain and complained to a deputy jailor, requesting medical care. Blackmore continued to complain about this pain. An entry in the Sergeant’s jail log reflects that at 5:00 p.m. on Sunday, May 28, 2000, Blackmore was “complaining of abdominal pain”. About that time, jail officials gave Blackmore antacids, but did not otherwise secure medical care.
At some unidentified time on Monday, May 29, 2000, Blackmore filed a “Request for Medical Care” in which he complained of “sharp” and “extreme a[b]dominal pain in the lower area” lasting twenty-six hours for which he needed medical attention “right away”. (J.A. 63). A later entry in the Sergeant’s jail log reflects: (1) that at 1:30 a.m., Blackmore “stated that he is having sharp abdominal pains;” (2) Black-more “had vomited and the antacids that were given to him earlier did not help;” and (3) that Blackmore “stated that the pains have been constant since Saturday afternoon .... ” (J.A. 70-71). At this time, jail officials placed Blackmore into an observation cell, but did not provide any medical treatment. Id.
At 6:30 a.m. Monday morning, over two complete days after his first complaint of pain, a jail nurse examined Blackmore and diagnosed him as “showing classic signs of appendicitis.” (J.A. 71). Blackmore was transported to a local hospital at approximately 7:00 a.m., and an appendectomy was successfully performed early that afternoon without complication.
Blackmore filed this action on May 13, 2002, asserting that the defendants violated his constitutional and civil rights. The gravamen of Blackmore’s claims was that the jailors violated his constitutional rights by denying him prompt medical care for a serious medical need and that the County violated his constitutional rights by failing to implement policies and to train jailors adequately to respond to inmates’ serious medical needs.
Upon completion of discovery, both parties moved for summary judgment. As noted earlier, the district court denied Blackmore’s motion, but granted summary judgment to Defendants, relying principally upon
Napier v. Madison County,
II. ANALYSIS
A. Standard of Review
This Court reviews
de novo
a district court’s grant of summary judg
*895
ment.
Terry Barr Sales Agency, Inc. v. All-Lock Co.,
As to Blackmore’s denial of medical care claim, the issue of “whether [Defendants] were deliberately indifferent is a mixed issue of law and fact.... The resolution of this question requires us to compare [Defendants’] conduct with a legal standard of deliberate indifference.”
Williams v. Mehra,
B. Deliberate Indifference
The Eighth Amendment forbids prison officials from “unnecessarily and wantonly inflicting pain” on an inmate by acting with “deliberate indifference” toward the inmate’s serious medical needs.
Estelle v. Gamble,
A constitutional claim for denial of medical care has objective and subjective components.
Farmer v. Brennan,
The subjective component requires an inmate to show that prison officials have “a sufficiently culpable state of mind in denying medical care.”
Brown,
The district court determined that Blackmore presented sufficient proof to create a material factual issue on whether the County acted with a “sufficiently culpable state of mind” to satisfy the subjective component of the “deliberate indifference” test. The district court, however, granted summary judgment, concluding that Black-more’s proof failed to satisfy the objective element, which requires proof, using “verifying medical evidence,” that his injury was “sufficiently serious.” Although we agree with the district court’s conclusion on the subjective factor, we disagree with the district court’s conclusion on the objective factor and the district court’s interpretation of Napier.
1. “Sufficiently culpable state of mind”
The district court found an issue of fact as to “when [the individual] Defendants knew the nature and duration of Plaintiffs abdominal pain, when they had reason to believe that Plaintiff required medical attention, and the length of the delay between such knowledge and Plaintiffs evaluation by a nurse.” (J.A. 220, Opinion at 6). We agree. Here, Black-more alleges that he began to complain of stomach pain within an hour of his arrival in the early morning hours on Saturday, May 27. It is undisputed that Sergeant’s Log entries at 5:00 p.m. on Sunday evening and at some point on Monday morning describe Blackmore as having “sharp abdominal pain.” Other undisputed facts are that Blackmore was given antacids by non-medical prison officials, that Black-more vomited, that he was placed in an observation cell, and that he did not receive any medical attention until 6:00 a.m. on Monday morning, over fifty hours after his arrest.
Viewing these facts in a light most favorable to the Plaintiff, we conclude that a reasonable jury could conclude that Defendants were “aware of facts from which the inference could be drawn that a substantial risk of serious harm exists and the Defendants ignored that risk.”
Farmer,
2. “Sufficiently serious” medical need
As to the objective component, a serious need for medical care,
Farmer
requires only that “the inmate show that he is incarcerated under conditions posing a substantial risk of serious harm;”
*897
Most other circuits hold that a medical need is objectively serious if it is “one that has been diagnosed by a physician as mandating treatment
or
one that is so obvious that even a lay person would easily recognize the necessity for a doctor’s attention.”
Gaudreault v. Municipality of Salem,
In unpublished opinions, this Court has evaluated the seriousness of a prisoner’s medical needs by this “obviousness” approach.
See, e.g., Taylor v. Franklin County,
This “obviousness” standard for determining a serious medical need is distinct from a separate branch of Eighth Amendment decisions where the seriousness of a prisoner’s medical needs “may
also
be decided by the
effect
of delay in treatment.”
Hill,
As reflected by its facts,
Napier
involved a claim about the effect of the delay in receiving medical treatment. In
Napier,
an arrestee suffering from kidney failure was kept from his scheduled dialysis while incarcerated for twenty-nine hours.
In sum, the “verifying medical evidence” requirement is relevant to those claims involving minor maladies or non-obvious complaints of a serious need for medical care.
Napier,
which was relied upon by the district court, falls within this branch of decisions. In a word,
Napier
does not apply to medical care claims where facts show an obvious need for medical care that laymen would readily discern as requiring prompt medical attention by competent health care providers.
Napier
applies where the plaintiffs “deliberate indifference” claim is based on the prison’s failure to treat a condition adequately, or where the prisoner’s affliction is seemingly minor or non-obvious. In such circumstances, medical proof is necessary to assess whether the delay caused a serious medical injury.
Napier,
*899 In dismissing this action, the district court noted that Blackmore’s appendix did not burst, and that there was “no evidence of any medical complications or consequences arising from the delay of treatment ... [or] that the delay contributed to the size or appearance of his surgical scar. There simply is no medical verification that his condition worsened as a result of the delay.” (J.A. 222). A determination that Blackmore’s appendix ruptured is not a prerequisite for his Eighth Amendment right to avoid the pain from the officers’ deliberate indifference to his obvious need for medical care.
Defendants were not preventing Black-more from attending a regularly-scheduled treatment. In Napier, the prisoner did not complain about missing treatment; told prison guards that missing a treatment was “no big deal”; missed over forty treatment sessions of his own accord; and neither sought immediate medical attention upon his release nor even attended his next scheduled treatment. The facts of this case differ greatly from those in Napier, where the injury to the prisoner’s kidney condition could not be discerned without competent medical proof.
The facts here are further distinguishable from
Napier
in that Blackmore’s claim falls under the “obviousness” line of decisions. Here, Blackmore did not suffer from a long-term and well monitored illness, but rather exhibited obvious manifestations of pain and injury. Blackmore complained of “sharp” and “severe” stomach pains for an extended period of time. Significantly, Blackmore vomited — a clear manifestation of internal physical disorder. The jailers deemed Blackmore’s condition sufficiently serious to place him in an observation cell. Blackmore complained orally and in writing for over two days before receiving medical treatment. With these facts, a jury could reasonably find that Blackmore had a serious need for medical care that was “so obvious that even a layperson would easily recognize the necessity for a doctor’s attention.”
Gaudreault,
As the Supreme Court has held, the test for deliberate indifference is whether there exists a
“stibstantial risk
of serious harm,”
Farmer,
To the extent our previous opinions would benefit from clarification, we hold today that where a plaintiffs claims arise from an injury or illness “so obvious
*900
that even a layperson would easily recognize the necessity for a doctor’s attention,”
Gaudreault,
In sum, we conclude that Blackmore presents sufficient evidence from which a jury can infer that his obvious need for medical care was “sufficiently serious” and that the Officers had a “sufficiently culpable state of mind.” Accordingly, summary judgment on this claim is reversed.
C. Liability of the County
The district court granted summary judgment to the County determining that because Blackmore failed to satisfy Napier’s verifying medical evidence requirement in his claim against the individual defendants, Blackmore’s claim against the County failed as a matter of law.
A municipality or county cannot be liable under § 1983 absent an underlying constitutional violation by its officers.
City of Los Angeles v. Heller,
A review of the record reveals that Blackmore presented evidence that the County did not have a formal written policy on how to deal with prisoner illnesses, and that the jail’s practice was not to provide a substitute nurse if the on-duty nurse calls in sick, resulting in times when a nurse is not on duty. Because we hold that verifying medical evidence is not required to state a claim for deliberate indifference where, as here, the seriousness of prisoner’s need for medical care is obvious, and because the record presents an issue of fact regarding the total lack of any County policies, practices, and adequate training for this type of constitutional claim, and regarding whether the harm complained of resulted from the County policies, or lack thereof, we reverse the district court’s grant of summary judgment for the County.
III. CONCLUSION
For the foregoing reasons, the district court’s grant of summary judgment to the Defendants is REVERSED, and this action is REMANDED to the district court for further proceedings consistent with this opinion.
Notes
. Plaintiff sued the following members of the County Sheriffs Department in their individual capacities: Deputy W. Misner, Deputy J. Harrison, Sergeant R. Fuller, Deputy D. Burke, Deputy J. Howke, Deputy P. Mitchell, Deputy S. Erdos, Deputy M. Gray, Deputy K. Bogart, Deputy T. Faulk, Sergeant M. Em-mert, Deputy J. Charon, Deputy J. Pardee, Deputy Donna DeNoon, Deputy D. Johnson, Deputy J. MacLagan, Deputy Art Lugar, Deputy J. Slone, Deputy J. Van Zile, and Sergeant W. Lawrence.
