# Wyatt, as Administratrix of the Estate of India T. Cummings v. County of Erie

> District Court, W.D. New York · August 5, 2020

URL: https://www.frixlaw.com/law-library/cases/10362649

## Case

- **Court:** District Court, W.D. New York
- **Decided:** August 5, 2020
- **Opinion:** 100trialcourt
- **Cited by:** 0 later opinions in the Frix Law Library

## Citator (automated)

- No negative treatment found by the automated citator. That is not the same as a confirmation that the case is good law; read the citing cases.
- Full citator and citing cases: https://www.frixlaw.com/law-library/cases/10362649

## How later opinions describe it (automated extraction)

- holding that disputes are part of the “same case or controversy” within § 1367 when they “derive from a common nucleus of operative fact”
- declining to deem a private physician a state actor were he “engaged in a single encounter with a prisoner presented for emergency treatment, which he was obligated under law to provide”

## Opinion text

UNITED STATES DISTRICT COURT
FOR THE
WESTERN DISTRICT OF NEW YORK
TAWANA R. WYATT, as )
Administrator of the Estate )
of INDIA T. CUMMINGS, )
)
Plaintiff, )
)
v. ) File No. 1:17-cv-446-wks
)
CITY OF LACKAWANNA, CITY OF )
LACKAWANNA POLICE DEPARTMENT, )
OFFICER JOHN-PAUL FIGLEWSKI, )
OFFICER BALCARCZYK, OFFICER )
JONES, CAPTAIN JOSEPH LEO, )
CAPTAIN ROBERT JANOWSKI, )
COUNTY OF ERIE, ERIE COUNTY )
SHERIFF’S OFFICE, SHERIFF )
TIMOTHY B. HOWARD, SHERIFF’S )
DEPUTY BEARING BADGE 1079, )
AMY JORDAN, R.N., BRIDGET )
LEONARD, HOLLANI GOLTZ, JILL )
LOBOCCHIARO, UNIVERSITY )
PSYCHIATRIC PRACTICE, INC., )
PETER MARTIN, M.D., EVELYN )
COGGINS, M.D., TOM CHAPIN, )
M.D., ERIE COUNTY MEDICAL )
CENTER CORPORATION, GERALD )
IGOE, M.D., TARA M. CIESLA, )
P.A., UNIVERSITY EMERGENCY )
MEDICAL SERVICES, INC., )
)
Defendants. )
OPINION AND ORDER
Plaintiff Tawana Wyatt, as administrator of the Estate of
India Cummings, brings this action alleging mistreatment related
to Cummings’ arrest, incarceration, and medical care. Pending
before the Court are motions filed by medical providers seeking
dismissal of Wyatt’s federal constitutional claims for failure to
meet the required legal standard, and her state law claims for
lack of supplemental jurisdiction. The first motion is submitted
by defendants Gerald Igoe, M.D., Tara M. Ciesla, P.A., and
University Emergency Medical Services, Inc. (“UEMS”)
(collectively “UEMS defendants”). ECF No. 110. The second
motion is submitted by defendant Erie County Medical Center
Corporation (“ECMCC”). ECF No. 123. For the reasons set forth
below, the motions to dismiss are granted.
Factual and Procedural Background
Wyatt alleges that on February 1, 2016, Cummings was
arrested and detained at the Erie County Holding Center (“ECHC”).
While in police custody she suffered a spiral fracture of her
left humerus. Cummings was subsequently transported to the
Emergency Department at Erie County Medical Center (“ECMC”) for
treatment of her broken arm. There, she was treated by Dr. Igoe
and Ms. Ciesla, both of whom are employees of UEMS. UEMS
reportedly contracts with ECMCC to provide emergency medical
services. Cummings was discharged at approximately 2:00 a.m. on

February 2, 2016 and returned to ECHC.
Over the course of the following two weeks, Cummings
allegedly became delusional and refused to eat or drink. On
February 17, 2016, she lost consciousness and showed no
observable heart rate or respiration. She was transported to
Buffalo General Hospital, where she was diagnosed with cardiac
arrest, severe dehydration, malnutrition, and organ failure. She
2
died at the hospital four days later.
Wyatt’s First Amended Complaint (“FAC”) asserted three
causes of action against the UEMS defendants. Two of those
causes of action alleged medical malpractice, while the third
alleged violations of Cummings’ civil rights under 42 U.S.C. §
1983. The FAC similarly asserted three causes of action against
ECMCC: one for medical malpractice, one for federal civil rights
violations, and one for wrongful death. The FAC claimed that Dr.
Igoe, Ms. Ciesla and ECMCC failed to properly diagnose and treat
Cummings’ physical and mental health conditions prior to her
discharge on February 2, 2016.
The UEMS defendants and ECMCC each moved to dismiss the FAC,
arguing that Wyatt had failed to state a claim under 42 U.S.C. §
1983 because her allegations fell short of alleging “deliberate
indifference” as required for a federal claim. They also argued
that in the absence of a valid federal claim, the Court lacked
jurisdiction over the remaining state law claims. The Court
agreed, dismissed Wyatt’s claims without prejudice, and granted
her leave to amend her pleadings.

Wyatt subsequently filed a Second Amended Complaint (“SAC”).
The SAC asserts four causes of action against the UEMS
defendants, including medical malpractice claims and a
constitutional claim under 42 U.S.C. § 1983. Wyatt has added a
“Monell claim” against UEMS. The SAC also asserts four causes of
3
action against ECMCC: one for medical malpractice, two under
Section 1983, and one for wrongful death. The factual
allegations in the SAC with respect to the UEMS defendants and
ECMCC are more specific than those set forth in the FAC. The SAC
highlights medical notes reporting that Cummings “states that a
man assaulted her, and pulled on her arm, breaking it.” The ECMC
Summary/Departure report noted that Cummings offered “multiple
stories for arm injury. Refusing to cooperat[e] w/ MD ... MD
aware and in to see patient.” The medical records also allegedly
state that the “[p]atient sustained an MVC” and was “unable to
recall the details of the accident, questionable loss of
consciousness, belted driver with airbag deployment. Patient is
uncertain when she sustained her injury.”
The SAC claims that the discrepancies in Cummings’
statements “should have alerted the ECMCC medical staff,
including [Dr. Igoe and Ms. Ciesla], to perform a further workup
including a chest x-ray and Mental Health referral, which they
failed to so perform.” The SAC further claims that defendants
failed to diagnose a medical condition revealed by Cummings’

blood work, which condition “may have contributed to her altered
mental state.” In summarizing her claim, Wyatt submits that
Cummings should not have been transferred from ECMC to ECHC on
February 2, 2016 because it was “evident to [defendants] that she
required immediate mental health diagnosis and treatment, and
4
required further diagnosis concerning her physical condition.”
An additional set of factual allegations in the SAC is
specific to ECMCC. Those allegations pertain to “9Z2 beds,”
which are described in the parties’ filings as forensic mental
health beds. When such beds were unavailable at ECMC, detainees
were returned to ECHC. The SAC alleges that it was the “custom,
practice, actions, policy, and/or failures of decisionmakers at
the ECMCC to maintain only two such beds for [inmates and
detainees] and to negligently, and or with gross negligence ...
send detainees to ECHC, where it was known or should have been
known ... that such inmates or patients would not receive the
requisite and adequate care” required by the Constitution.
The SAC also includes, as an attachment, a Commission Report
issued after a special investigation into Cummings’ treatment.
The Commission Report states, in relevant part: “The Medical
Review Board finds that the discrepancy in the cause of the
injury and the multiple car accidents prior to her arrest with
the altered mental status should have alerted the ECMC medical
staff to perform a further workup including a chest x-ray and

Mental Heath referral.” The movants now argue that the Medical
Review Board’s conclusions, as well as each of the allegations
set forth in the SAC, may reflect medical malpractice but do not
rise to deliberate indifference as required for a federal civil
rights claim. Consequently, they have moved for dismissal of the
5
federal causes of action for failure to state a claim, and
dismissal of the state law claims for lack of supplemental
jurisdiction.
Discussion
I. Motion to Dismiss Standards
The movants seek dismissal of Wyatt’s federal claims under
Federal Rule of Civil Procedure 12(b)(6). Rule 12(b)(6) provides
for dismissal of a complaint for “failure to state a claim upon
which relief can be granted.” Fed. R. Civ. P. 12(b)(6). “To
survive a motion to dismiss, a complaint must contain sufficient
factual matter, accepted as true, to ‘state a claim to relief
that is plausible on its face.’” Ashcroft v. Iqbal, 556 U.S.
662, 678 (2009) (quoting Bell Atl. Corp. v. Twombly, 550 U.S.

544, 570 (2007)). In assessing whether a plaintiff has met this
standard, the Court must “constru[e] the complaint liberally,
accepting all factual allegations ... as true, and drawing all
reasonable inferences in the plaintiff’s favor .” Goldstein v.
Pataki, 516 F.3d 50, 56 (2d Cir. 2008).
“On a motion to dismiss, courts ‘are not bound to accept as
true a legal conclusion couched as a factual allegation.’”
Sharkey v. Quarantillo, 541 F.3d 75, 83 (2d Cir. 2008) (quoting
Papasan v. Allain, 478 U.S. 265, 286 (1986)). More than “labels
and conclusions” are required, and “a formulaic recitation of the
elements of a cause of action will not do.” Twombly, 127 S. Ct.
6
at 1965. Accordingly, “bald assertions and conclusions of law
will not suffice.” Reddington v. Staten Island Univ. Hosp., 511
F.3d 126, 132 (2d Cir. 2007).
The parties have also moved for dismissal of Wyatt’s state
law claims for lack of supplemental jurisdiction. Under Federal
Rule of Civil Procedure 12(b)(1), a case is dismissed for lack of
subject matter jurisdiction when the federal court lacks the
power to adjudicate it. Makarova v. United States, 201 F.3d 110,
113 (2d Cir. 2000). A district court may exercise supplemental
jurisdiction over state law claims under 28 U.S.C. § 1367. 28
U.S.C. § 1367(a). Section 1367(c)(3) provides that a district
court “may” decline to exercise supplemental jurisdiction when it
has dismissed the related federal claims. 28 U.S.C. §
1367(c)(3). Accordingly, the statute is permissive rather than
mandatory. See generally Marcus v. AT&T Corp., 138 F.3d 46, 57
(2d Cir. 1998).

II. Constitutional Claims
Wyatt brings her constitutional claims against the UEMS
defendants and ECMCC pursuant to 42 U.S.C. § 1983. The UEMS
defendants argue that they cannot be sued under 42 U.S.C. § 1983
because they are not state actors. As a general rule, private
entities are not liable under Section 1983. See National
Collegiate Athletic Ass’n v. Tarkanian, 488 U.S. 179, 191 (1988).
There is an exception, however, when “conduct that is formally
7
‘private’ may become so entwined with governmental policies or so
impregnated with a governmental character as to become subject to
the constitutional limitations [p]laced upon state action.”
Perez v. Sugarman, 499 F.2d 761, 764 (2d Cir. 1974).
The actions of nominally private entities are
attributable to the state when those actions meet one
of three tests: [1] [t]he compulsion test[, where] the
entity acts pursuant to the coercive power of the state
or is controlled by the state[;] [2] [t]he public
function test[, where] the entity has been delegated a
public function by the [s]tate[;] or, [3] [t]he joint
action test or close nexus test[, where] the state
provides significant encouragement to the entity, the
entity is a willful participant in joint activity with
the [s]tate, or the entity’s functions are entwined
with state policies.

Hollander v. Copacabana Nightclub, 624 F.3d 30, 34 (2d Cir. 2010)
(internal quotation marks omitted) (quoting Sybalski v. Indep.
Grp. Home Living Program, Inc., 546 F.3d 255, 257 (2d Cir.
2008)).
Here, the UEMS defendants do not qualify as state actors
under any of these three tests. First, their treatment of
Cummings was not compelled by means of a contract with the State
or otherwise. Indeed, there is no allegation that the UEMS
defendants contracted specifically to provide medical care to
inmates or detainees. Second, their work as emergency room
health care providers was not a delegated public function, and
third, they were not engaged in a joint activity with the state.
See Koulkina v. City of New York, 559 F. Supp. 2d 300, 320
(S.D.N.Y. 2008) (“Private physicians are generally not state
8
actors, especially where the physician is ‘not performing a
function traditionally reserved for the State and where [the
physician] was not under contract with the State to provide
medical services.’” (quoting Vazquez v. Marciano, 169 F. Supp. 2d
248, 253–54 (S.D.N.Y. 2001)); see also Sykes v. McPhillips, 412
F. Supp. 2d 197, 204 (N.D.N.Y. 2006) (declining to deem a private
physician a state actor were he “engaged in a single encounter
with a prisoner presented for emergency treatment, which he was
obligated under law to provide”).
The SAC alleges that Dr. Igoe and Ms. Ciesla “were state
actors under color of law of a statute ordinance, regulation,
custom, or usage [of] the law of New York State with respect to
the care and treatment of [Cummings] while a patient at ECMCC
facilities and an inmate in the ECHC.” The Second Circuit has
held, however, that “a private entity does not become a state
actor for purposes of Section 1983 merely on the basis of the
private entity’s creation, funding, licensing, or regulation by

the government.” Fabrikant v. French, 691 F.3d 193, 207 (2d Cir.
2012). When treating Cummings, the providers in question made
decisions based upon their medical judgment, and not upon any
specific law or regulation. Their decisions were not mandated by
the state, and their treatment of Cummings did not amount to
state action. See, e.g., Johnson v. Fein, No. 9:18-CV-96
(DNH/DEP), 2019 WL 1877584, at *6 (N.D.N.Y. Mar. 25, 2019),
9
report and recommendation adopted, 2019 WL 1877296 (N.D.N.Y. Apr.
26, 2019) (“Dr. Fein’s treatment decisions resulted from ‘pure
medical judgment,’ which dispels any notion of state
compulsion.”); see also Davis v. Cole-Hoover, No. 03-CV-0550,
2004 WL 1574649, at *10 (W.D.N.Y. June 14, 2004) (“[T]he medical
decisions of private doctors at issue here do not reflect
government influence or inducement.”).
The UEMS defendants, together with ECMCC, also argue that
the SAC fails to allege a viable constitutional claim. Because
Cummings was a pretrial detainee, the legal standard to be
applied comes from the Due Process Clause. Darnell v. Pineiro,
849 F.3d 17, 29 (2d Cir. 2017) (“A pretrial detainee’s claims of
unconstitutional conditions of confinement are governed by the
Due Process Clause of the Fourteenth Amendment, rather than the
Cruel and Unusual Punishments Clause of the Eighth Amendment.”).
That standard provides that “[a] pretrial detainee may establish

a § 1983 claim for allegedly unconstitutional conditions of
confinement by showing that the officers acted with deliberate
indifference to the challenged conditions.” Darnell, 849 F.3d at
29.
To state a claim of deliberate indifference, a plaintiff
must satisfy two elements: (1) an “objective” element, which
requires a “showing that the challenged conditions were
sufficiently serious to constitute objective deprivations of the
10
right to due process,” and (2) a “subjective” element, which
requires a “showing that the officer acted with at least
deliberate indifference to the challenged conditions.” Id. In
the context of medical care, the plaintiff first “must show that
the conditions, either alone or in combination, pose[d] an
unreasonable risk of serious damage to [the detainee’s] health.”
Walker v. Schult, 717 F.3d 119, 125 (2d Cir. 2013) (citing Rhodes
v. Chapman, 452 U.S. 337, 347 (1981)). The second element
requires the plaintiff to allege “that the [defendant] acted
intentionally to impose the alleged condition, or recklessly
failed to act with reasonable care to mitigate the condition
posed to the pretrial detainee even though the [defendant] knew,
or should have known, that the condition posed an excessive risk
to health or safety.” Darnell, 849 F.3d at 35.
In order to meet the objective requirement, the alleged

deprivation of adequate medical care must be “sufficiently
serious.” Salahuddin v. Goord, 467 F.3d 263, 279 (2d Cir. 2006)
(citing Farmer v. Brennan, 511 U.S. 825, 834 (1994)). In
assessing seriousness, the Court must examine how the care was
allegedly inadequate and that how inadequacy caused or would
likely cause the plaintiff harm. Id. (citing Helling v.
McKinney, 509 U.S. 25, 32–33 (1993)).
Here, Wyatt claims that ECMC Emergency Department providers,
including Dr. Igoe and Ms. Ciesla, “were aware of the objectively
11
serious medical conditions of decedent and ... with deliberate
indifference did fail to act, to ignore the life-threatening or
fast-degenerating condition of decedent ... even though
defendants knew or should have known the conditions posed an
excessive risk to the health or safety of decedent.” The factual
allegations underlying these claims consist primarily of the
Commission Report and the finding by the Medical Board. The
Medical Board concluded that the providers should have taken
additional action, including ordering a chest x-ray and a mental
health referral, and should have identified a medical condition
revealed by Cummings’ blood work. The movants now contend that,
even accepting the Medical Board’s conclusions, the facts alleged
do not amount to a plausible claim of deliberate indifference to
a serious medical need.
The allegations in the SAC state that Cummings arrived at
ECMC with a broken arm. That injury was treated, and she was
soon returned to ECHC. Over the next two weeks Cummings
displayed behavior and medical issues that resulted in her
ultimate admission to Buffalo General Hospital. There is no

doubt that Cummings’ condition became objectively serious during
her weeks of detention.
The question presented here is whether, when faced with
inconsistent statements about the origins of her arm injury, it
should have been apparent that Cummings had other serious medical
12
needs. If the Court assumes for the sake of argument that
Cummings’ needs were objectively serious when she arrived at
ECMC, it must turn to the subjective element of the test. The
subjective element asks whether the official acted with “a
sufficiently culpable state of mind.” Farmer, 511 U.S. at 834
(citing Wilson v. Seiter, 501 U.S. 294, 300 (1991)). In order to
satisfy this element, Wyatt must demonstrate more than a
negligent failure to provide adequate medical care and, as stated
above, must instead show deliberate indifference. “Deliberate
indifference is a mental state equivalent to subjective
recklessness, as the term is used in criminal law. This mental
state requires that the charged official act or fail to act while
actually aware of a substantial risk that serious inmate harm
will result.” Salahuddin, 467 F.3d at 280 (citations omitted).
As the movants properly contend, the SAC fails to set forth
a plausible allegation that Cummings’ health care providers were

aware of a risk of serious medical harm and nonetheless failed to
act. The Medical Board reportedly found that additional
diagnostic steps should have been taken. Relying on that
conclusion, Wyatt claims that the providers should have performed
a chest x-ray and ordered a mental health evaluation. There is
also an allegation that blood work was not properly assessed. In
Estelle v. Gamble, the Supreme Court noted that “the question
whether an X-ray or additional diagnostic techniques or forms of
13
treatment is indicated is a classic example of a matter for
medical judgment. A medical decision not to order an X-ray, or
like measures, does not represent cruel and unusual punishment.”
429 U.S. 97, 107 (1976). Likewise, a “complaint that a physician
has been negligent in diagnosing or treating a medical condition
does not state a valid claim of medical mistreatment under the
[Constitution].” Id. at 106.
Cummings was taken to ECMC for treatment of arm pain and was
treated for a broken arm. There is no allegation that she was
either ignored or denied medical care for that injury. A claim
that her varied explanations, and her confused mental state
generally, should have alerted providers to other medical or
mental health issues constitutes an allegation of negligence.
There are no allegations from which the Court can reasonably
infer deliberate indifference on the part of Dr. Igoe, Ms.
Ciesla, or other Emergency Department personnel. Accordingly,
the SAC fails to state a plausible federal claim against the UEMS
defendants and ECMC medical staff.

In addition to claims regarding treatment by individual
providers, Wyatt brings allegations of unconstitutional customs
or policies by ECMCC and UEMS. The SAC alleges generally that
the movants failed to properly train or supervise their
subordinates, and that such failure amounted to deliberate
indifference. This general allegation does not reference any
14
specific factual claims, and is in itself too conclusory to
support a cause of action.1
ECMCC is more specifically accused of having an unlawful
custom or policy with respect to inpatient mental health beds.
The SAC alleges that “[a] 9Z2 bed is an inpatient mental health
bed at the ECMCC facility that can provide a higher level of
psychiatric inpatient care.” ECMC reportedly had two such beds.
Although ECMCC had an agreement with Erie County to offer those
beds for inmate or detainee use, when the beds are not made
available the detainee is allegedly returned to ECHC, “resulting
in the denial of adequate medical treatment.”
ECMCC does not dispute that it may be subject to a claim of
municipal liability under Monell v. City of New York Department
of Social Services, 436 U.S. 658, 691-95 (1978). To hold ECMCC
liable under Monell and Section 1983, Wyatt must show an official
policy or custom that caused the plaintiff to be subjected to a

denial of a constitutional right. See Wary v. City of New York,
490 F.3d 189, 195 (2d Cir. 2007). The Second Circuit has held
that “a single incident alleged in a complaint, especially if it
involved only actors below the policy-making level, does not
suffice to show a municipal policy.” Ricciuti v. N.Y.C. Transit
1 To the extent the SAC is claiming liability purely on the
basis of an employer-employee relationship, it is well
established that respondeat superior is not a basis for liability
under Section 1983. See Hernandez v. Keane, 341 F.3d 137, 144
(2d Cir. 2003).
15
Authority, 941 F.2d 119, 123 (2d Cir. 1991).
Here, the claims regarding 9Z2 beds are insufficient in
several respects. First, for reasons discussed above, there is
no plausible claim that the failure to provide Cummings with such
a bed was a constitutional violation. Moreover, there is no
allegation that ECMCC had a custom or policy of returning
detainees or inmates to ECHC when they are psychiatrically
unstable, regardless of 9Z2 bed availability. Nor is there an
allegation that all 9Z2 beds were full when Cummings was at ECMC
on the night of February 1, 2016. Finally, any alleged harm
focuses on a single incident, yet Second Circuit precedent
requires more. See Ricciuti, 941 F.2d at 123; Newton v. City of
New York, 566 F. Supp. 2d 256 271 (S.D.N.Y. 2008) (“[A] custom or
policy cannot be shown by pointing to a single instance of
unconstitutional conduct by a mere employee of the State.”).
In opposition to ECMCC’s motion to dismiss, Wyatt argues

that the psychiatric bed allegation is not limited to February 1,
2016, but instead extends to a later period that same month when
Wyatt was being held at ECHC and was allegedly waiting for access
to a 9Z2 bed. The SAC claims that Cummings was “identified for a
9Z2 bed” by an ECHC interdisciplinary team but was “still
awaiting bed availability,” and that no effort was made to take
her back to ECMC. That allegation does not support a claim that
ECMCC had a custom or policy of denying proper psychiatric care
16
to detainees or inmates who were being attended to at ECMC, or
that ECMCC was aware that Cummings or others held at ECHC were
denied such care. The SAC therefore fails to state a plausible
Monell claim against ECMCC, and the federal claims against the
movants are dismissed.
III. State Law Claims
With no plausible federal constitutional claims pending
against them, the movants seek dismissal of Wyatt’s state law
claims. As noted above, 28 U.S.C. § 1367(c)(3) makes the
exercise of supplemental jurisdiction discretionary when the
related federal claims have been dismissed. The Supreme Court
has held that “when the federal-law claims have dropped out of
the lawsuit in its early stages and only state-law claims remain,
the federal court should decline the exercise of jurisdiction by
dismissing the case without prejudice.” Carnegie-Mellon Univ. v.

Cohill, 484 U.S. 343, 350 (1988). In keeping with this guidance,
dismissal of the state law claims brought against the movants is
warranted.
The Court also notes that the remaining federal claims,
brought against other defendants, revolve mostly around Cummings’
treatment during her arrest and her approximately two weeks of
detention prior to her death. Because the UEMS defendants and
ECMCC played no role in either the arrest or the multi-day
detention, the remaining federal claims bear only a thin
17
relationship to the state law claims being brought against the
movants. See Promisel v. First Am. Artificial Flowers Inc., 943
F.2d 251, 254 (2d Cir. 1991) (holding that disputes are part of
the “same case or controversy” within § 1367 when they “derive
from a common nucleus of operative fact”). Their motions to
dismiss the state law claims are therefore granted and those
claims are remanded to the state court.2
Conclusion
For the reasons set forth above, the motions to dismiss
filed by Gerald Igoe, M.D., Tara M. Ciesla, P.A., and University
Emergency Medical Services, Inc. (ECF No. 110) and Erie County
Medical Center Corporation (ECF No. 123) are granted. The state
law claims brought against those defendants are remanded to state
court.

DATED at Burlington, Vermont, this 5th day of August, 2020.

/s/ William K. Sessions III
William K. Sessions III
U.S. District Court Judge

2 This case was originally filed in the New York State
Supreme Court, Erie County.
18

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Source: Frix Law Library, https://www.frixlaw.com/law-library/cases/10362649. Public record. Not legal advice.