# Smothers v. Childers

> District Court, N.D. Alabama · September 17, 2024

URL: https://www.frixlaw.com/law-library/cases/10631244

## Case

- **Court:** District Court, N.D. Alabama
- **Decided:** September 17, 2024
- **Opinion:** 100trialcourt
- **Cited by:** 0 later opinions in the Frix Law Library

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## Opinion text

UNITED STATES DISTRICT COURT
FOR THE NORTHERN DISTRICT OF ALABAMA
JASPER DIVISION
PAMELA SMOTHERS, }
}
Plaintiff, }
}
v. } Case No.: 6:21-CV-01057-RDP
}
ROGER CHILDERS, et al., }
}
Defendants. }
}

MEMORANDUM OPINION
This matter is before the court on Defendant Walker County, Alabama’s (“Walker
County”) Motion for Summary Judgment. (Doc. # 69). The parties have fully briefed the motion.
(Docs. # 77, 82, 83). For the reasons explained below, Walker County’s Motion for Summary
Judgment is due to be granted.
I. Background and Procedural History
Plaintiff, as the administrator and personal representative of Mitchell Wayne Smothers
Junior’s (“Mr. Smothers”) estate,1 brings this action seeking damages for Mr. Smothers’s death.
(Doc. # 3). Plaintiff alleges that Mr. Smothers died because of inadequate medical care while he
was housed in the Walker County Jail. (Id. at 3-5, 29-31). Plaintiff named Roger Childers,
Preemptive Forensic Health Solutions (“PFHS”), and Walker County as defendants in addition to
fictitious parties. (Id.).
On June 4, 2024, the court dismissed the case without prejudice as to Defendants Roger
Childers and PFHS, after having been informed that settlements had been reached between

1 Plaintiff is also Mr. Smothers’s mother.
Plaintiff and those parties. (Doc. # 85). The court’s partial dismissal order was modified on June
11, 2024, when this court ordered that these claims be dismissed with prejudice (Doc. # 90) in
accordance with the Stipulations of Dismissal between Plaintiff and Roger Childers (Doc. # 88)
and between Plaintiff and PFHS (Doc. # 89). Walker County is the only remaining Defendant
named in Plaintiff’s First Amended Complaint.

The only cause of action that Plaintiff brings against Walker County is a § 1983 failure to
fund claim. (Doc. # 3 at 29-31). Plaintiff alleges that “Walker County has a duty to pay for medical
care provided to inmates.” (Id. at ¶ 122). Plaintiff also claims that Walker County was deliberately
indifferent in continuing a contractual relationship with PFHS because it knew PFHS could not
provide (or did not provide) the necessary medical care and that PFHS was only selected because
it was the lowest-cost medical provider. (Id. at ¶¶ 39, 123-28). Walker County’s Motion for
Summary Judgment (Doc. # 69) argues that although it has a statutory duty to pay for necessary
inmate medical care, it does not have a duty to manage medical care by removing a provider once
put on notice that the medical care was low quality. (Doc. # 77 at 1-2). Walker County further

argues that it met this duty by engaging with PFHS in a contract to provide “basic and adequate”
medical services and by allocating 60% of the County budget to the Sheriff’s Office – 8% of which
paid for inmate medical care. (Doc. # 77 at 1-2).
II. Standard of Review
Under Federal Rule of Civil Procedure 56, summary judgment is proper “if the pleadings,
depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any,
show that there is no genuine issue as to any material fact and that the moving party is entitled to
judgment as a matter of law.” Celotex Corp. v. Catrett, 477 U.S. 317, 322 (1986). The party asking
for summary judgment always bears the initial responsibility of informing the court of the basis
for its motion and identifying those portions of the pleadings or filings which it believes
demonstrate the absence of a genuine issue of material fact. Id. at 323. Once the moving party has
met its burden, Rule 56 requires the non-moving party to go beyond the pleadings and – by pointing
to affidavits, or depositions, answers to interrogatories, and/or admissions on file – designate
specific facts showing that there is a genuine issue for trial. Id. at 324.

The substantive law will identify which facts are material and which are irrelevant. See
Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986). All reasonable doubts about the facts
and all justifiable inferences are resolved in favor of the non-movant. See Allen v. Bd. of Pub.
Educ. for Bibb Cnty., 495 F.3d 1306, 1314 (11th Cir. 2007); Fitzpatrick v. City of Atlanta, 2 F.3d
1112, 1115 (11th Cir. 1993). A dispute is genuine “if the evidence is such that a reasonable jury
could return a verdict for the nonmoving party.” Anderson, 477 U.S. at 248. If the evidence is
merely colorable, or is not significantly probative, summary judgment may be granted. See id. at
249.
When faced with a “properly supported motion for summary judgment, [the nonmoving

party] must come forward with specific factual evidence, presenting more than mere allegations.”
Gargiulo v. G.M. Sales, Inc., 131 F.3d 995, 999 (11th Cir. 1997). As Anderson teaches, under Rule
56(c) a plaintiff may not simply rest on her allegations made in the complaint; instead, as the party
bearing the burden of proof at trial, she must come forward with at least some evidence to support
each element essential to her case at trial. See Anderson 477 U.S. at 252. “[A] party opposing a
properly supported motion for summary judgment ‘may not rest upon the mere allegations or
denials of his pleading, but . . . must set forth specific facts showing that there is a genuine issue
for trial.’” Id. at 248 (citations omitted).
Summary judgment is mandated “against a party who fails to make a showing sufficient to
establish the existence of an element essential to that party’s case, and on which that party will
bear the burden of proof at trial.” Celotex Corp., 477 U.S. at 322. “Summary judgment may be
granted if the non-moving party’s evidence is merely colorable or is not significantly probative.”
Sawyer v. Sw. Airlines Co., 243 F. Supp. 2d 1257, 1262 (D. Kan. 2003) (citing Anderson, 477 U.S.

at 250-51).
“[A]t the summary judgment stage the judge’s function is not himself to weigh the evidence
and determine the truth of the matter but to determine whether there is a genuine issue for trial.”
Anderson, 477 U.S. at 249. “Essentially, the inquiry is ‘whether the evidence presents a sufficient
disagreement to require submission to the jury or whether it is so one-sided that one party must
prevail as a matter of law.’” Sawyer, 243 F. Supp. 2d at 1262 (quoting Anderson, 477 U.S. at 251-
52); see also LaRoche v. Denny’s, Inc., 62 F. Supp. 2d 1366, 1371 (S.D. Fla. 1999) (“The law is
clear . . . that suspicion, perception, opinion, and belief cannot be used to defeat a motion for
summary judgment.”).

III. Factual Background
The court has gleaned the facts set out in this opinion from the parties’ submissions and
the court’s own examination of the evidentiary record. All reasonable doubts about the facts have
been resolved in favor of the nonmoving party. See Info. Sys. & Networks Corp. v. City of Atlanta,
281 F.3d 1220, 1224 (11th Cir. 2002). These are the “facts” for summary judgment purposes only.
They may not be the actual facts that could be established through live testimony at trial. See Cox
v. Adm’r U.S. Steel & Carnegie Pension Fund, 17 F.3d 1386, 1400 (11th Cir. 1994).
In 2009, the Walker County Commission entered into a Contract for Services (hereinafter
referred to as “CFS”)2 with Alabama-based third-party medical provider PFHS for the provision
of comprehensive onsite medical services for inmates in the Walker County Jail in exchange for
$168,000 annually in payments of $14,000 per month. (Doc. # 70-5 at 5). Walker County
Administrator Robbie Dickerson testified that PFHS was one of the lowest-cost providers that

submitted bids to Walker County to provide medical care for the Walker County Jail. (Doc. # 70-
1 at 30). The 2009 CFS indicated that PFHS would “provide basic medical care, treatment(s) and
services(s) [sic] to the ‘County’ inmates of the ‘County Jail’ seven (7) days per week.” (Doc. # 70-
5 at 2). The CFS further provided that “Physicians will come [to] the jail for formal clinic one (1)
day per week,” and that PFHS “will have a physician on call and available to the nurses and jail
staff for special situations seven (7) days per week, twenty-four (24) hours per day.” (Id. at 3).
Additionally, the CFS provides that PFHS “will have a nurse available at the jail seven (7) days
per week during defined hours” and that the “nurse will administer medication” and schedule
necessary appointments for County inmates (including “appointment(s) with specialists”). (Id.).

These appointments included for “[d]ental, orthopedics, ophthalmologist, MRI, X-rays, lab work
or other medical treatment(s) or need(s) requiring appointment(s) with specialists” as ordered by
the jail physician. (Id.).
Relevant to cost and payment, the CFS specified certain services to be provided by PFHS
“so as to minimize the cost incurred to Walker County from the use of other medical facilities.”
(Id. at 4). These services include “[c]leansing and dressing of wounds,” as well as “[o]rdering and
stocking any necessary medication(s).” (Id.). And, the CFS committed the County to “be

2 The County and PFHS entered into three separate contracts (or CFS), each containing substantially the same
terms. This statement of facts cites to the third CFS for contract specifics because that third CFS was the operative
contract at the time giving rise to this lawsuit.
responsible for the payment of all reasonable and necessary medical expenses.” (Id.). Last, the
CFS provided that “[i]f, in the opinion of the ‘County’, the ‘Provider’ is not in compliance with
the terms and obligations set forth above . . . then the County” may give “60 days’ notice to correct
any alleged deficiency.” (Id. at 6).
In 2012, the County renewed the CFS with PFHS for similar services as those specified in

the 2009 CFS in exchange for $181,440 in payments of $15,120 per month. (Doc. # 70-6 at 5).
Differences between the 2009 and 2012 CFS include that the 2012 CFS only required a “medical
team including a Physician, dentist or advanced practice nurse” rather than specifically
“[p]hysicians” to “come to the jail for formal clinic one (1) day per week.” (Id. at 3). Similarly,
while the 2009 CFS required PFHS to have a “[p]hysician” on call and available to staff nurses,
the 2012 CFS required “a physician, dentist or advanced practice nurse” to be on call. (Id.)
(emphasis added). Additionally, while the 2009 CFS only required one nurse to administer
medication and make necessary appointments for inmates at the jail seven (7) days per week, the
2012 CFS required “two nurses” to do so. (Id.).
The President and Owner of PFHS is “Dr.”3 Roger Childers, a registered nurse licensed to

practice nursing in the state of Alabama. (Doc. # 72-1 at 6-7). On September 2, 2015, Childers
wrote to the Walker County Commission a letter touting the care and savings that he provided,
stating that he had cut costs on the pharmaceutical budget, transferred fewer inmates out of jail for
medical visits because of the medical care provided by PFHS (including the provision of all dental
care for inmates inhouse at the jail, the provision of two licensed RN’s or LPN’s every morning

3 As the 2016 CFS explained, Roger Childers held a Ph.D., but was not a medical doctor, so he was not
allowed to “sign any medical treatment forms prepared for the County as ‘Dr. Childers’ in order to avoid any confusion
with his educational credentials.” (Docs. # 70-9 at 7; # 70-1 at 26). Sheriff Smith testified that Childers repeatedly
referred to himself in emails as “Dr. Childers,” and that this “supported things that we had been hearing about him not
being an actual doctor.” (Doc. # 70-2 at 56).
and two licensed RN’s or LPNs every evening 365 days a year) and converted all inmate medical
records to be stored electronically. (Doc. # 70-7 at 2-3).
On July 24, 2016, in response to a question from the Commission regarding who was the
physician that PFHS used and the frequency that the physician came to the jail, Childers sent an
email to the Commission stating that Dr. Ajmal Kahn came to the jail monthly “as does the dentist

and or [sic] an advanced practice nurse.” (Doc. # 70-8 at 2). The CFS in place at the time of this
email required a “medical team including a Physician, dentist or advanced practice nurse” to “come
to the jail for formal clinic one (1) day per week” (Doc. # 70-6 at 3) (emphasis added), rather than
just one day per month. (See Doc. # 70-8 at 2).
On September 6, 2016, the County renewed the CFS with PFHS for the same onsite
services in exchange for $208,464 annually in payments of $17,372 per month. (Doc. # 70-9 at 6).
The term of the 2016 CFS ran from October 1, 2016, to September 30, 2018, (Id. at 8), and after
the original term expired, the contract was continued month-to-month. (Doc. # 70-1 at 33). The
2016 CFS differed from the 2009 and 2012 CFS by requiring PFHS to provide “basic and adequate

medical care, treatment(s) and service(s) to the County inmates.” (Doc. # 70-9, at 3). The CFS
added that the “medical team” provided for in the 2012 CFS must be “properly licensed and
credentialed.” (Id.). And, while the 2009 and 2012 CFS used the language “[i]f, in the opinion of
the County” before describing the procedure for notice and curing of any deficiency under the
contract, the 2016 CFS used the language “[i]f, in the sole discretion of the County.” (Id. at 8).
In 2017, the County was facing possible bankruptcy. (Doc. # 70-1 at 30). Expenditure cuts
were made in fuel, utilities, cell phones, and insurance costs. (Id.). Despite these cuts, the
proportion of the general fund budget allocated to the Sheriff’s Office increased from 45% in the
fiscal year 2008-2009 to 51% in the fiscal year 2017-2018 and 60% in 2018-2019. (Doc. # 70-10
at 2). This resulted in only a small decrease in the jail’s budget. While Sheriff Smith was budgeted
$5,806,457.56 in 2016-2017, he received $5,036,986.78 in 2017-2018 and the amount went back
up to $5,935,889.64 in 2018-2019. (Doc. # 70-10 at 3).
Walker County Administrator Robbie Dickerson testified she was aware, based on legal
documentation, that after PFHS’s contract began, several inmates had died and that there were

complaints that these deaths were due to a lack of medical care. (Doc. # 70-1 at 27) (confirming
familiarity with at least the names of deceased Walker County Jail inmates Nelson Tidwell, Terry
Benton, Autumn Harris, and Anthony Hunt). When campaigning for sheriff in 2018, one of Sheriff
Nick Smith’s campaign issues was the low quality of medical care provided at the Walker County
Jail. (Doc. # 70-2 at 46).
Once elected Sheriff in January 2019, Sheriff Smith did not have the authority to cancel
the contract with Childers or PFHS. (Docs. # 70-2 at 47-48; # 70-1 at 33; # 70-3 at 19). Sheriff
Smith did, however, have the responsibility to ensure the CFS with PFHS was being complied
with. (Doc. # 70-1 at 34). While administering the CFS, Sheriff Smith voiced concerns to Walker

County that PFHS was providing only CNAs (nurse assistants) rather than nurses, as required by
the CFS. (Id. at 27, 34).4 Additionally, according to the testimony of Walker County Jail
Correctional Officer Jottie Tidwell, Sheriff Smith made it “abundantly clear” that he was
concerned that PFHS was not providing proper medical treatment to inmates. (Doc. # 70-3 at 24-
25; see also id. at 19).
Before Mr. Smothers’s death, another inmate, Mindy Tidwell, died due to purported
inadequate health care at the jail. (Doc. # 70-2 at 47-49). Sheriff Smith discussed with County
Commissioner Chairman Jerry Bishop his concerns about the low quality of medical care being

4 Robbie Dickerson noted that Sheriff Smith did not give an example of what he thought was substandard
care given by the CNA. (Doc. # 70-1 at 35).
provided by Childers and PFHS, and specifically the concern that Childers was not following the
CFS. (Id.). Sheriff Smith testified that Mr. Bishop indicated that because “it was his election cycle
. . . we would address the contract and the bid after the election.” (Id. at 57). Around July 2019,
Sheriff Smith also instructed his correctional officers at the Walker County Jail that “if someone
complained about their toe being stubbed, send them to the hospital.” (Docs. # 70-2 at 18, 23-24;

# 70-3 at 25). Additionally, Sheriff Smith directed Childers to “email me every day what problems
we had inside the facility as far as inmates that were vulnerable” (Doc. # 70-2 at 48), which
Childers began doing. (Id. at 53). The medical expenses for inmates’ health care roughly doubled
after this policy was implemented. (Id. at 50).
According to Sheriff Smith, the County Commission never refused to pay a bill for outside
medical care for inmates. (Id. at 59). The Commission, specifically Robbie Dickerson, did question
why the jail’s outside medical billing was increasing, but the County Commission never directed
Sheriff Smith to end this policy. (Id. at 48, 59). Walker County also never took money out of other
areas of Sheriff Smith’s budget due to this policy change. (See id. at 59). Additionally, when

Sheriff Smith asked Walker County to increase the daily time allocated for jail medical care from
eight-hour days to sixteen-hour days, they agreed and paid for that increase. (Id. at 60).
Mr. Smothers, the Plaintiff’s decedent, was an Alabama Department of Corrections inmate
held at the Walker County Jail from February 12, 2019 through August 6, 2019 for failure to report
to his Probation Officer. (Docs. # 3 ¶ 93; # 81-1 at 4-6). Mr. Smothers’s medical conditions
included liver cirrhosis secondary to hepatitis C and alcoholism, COPD, chronic venous
insufficiency, recurrent cellulitis, and the formation of non-healing pressure wounds. (Docs. # 3 ¶
3; # 81-8 at 3-5; # 81-2 at 57). Mr. Smothers was in significant pain after his arrest, and often told
his mother, Plaintiff, about this pain. (Doc. # 70-4 at 34). Mr. Smothers later told Plaintiff that “the
only thing that they would give him was ibuprofen,” even though he had been on antibiotics, a
water pill, antacids, and stomach medicine at the time of his arrest. (Id. at 36).5 Mr. Smothers told
Plaintiff that he did not complain about his health issues to anyone at the jail and did not request
medication that was not received. (Doc. # 70-4 at 37-39).6 Plaintiff also never visited or called the
Sheriff or the jail to tell them that Mr. Smothers needed medical treatment. (Id. at 37).

By May or June 2019, Mr. Smothers told Plaintiff that “he was passing pure blood and he
could not stand on his own” (Id. at 38), and that he was having “[t]remendous stomach pain.” (Id.
at 39). At some point, Mr. Smothers had also told Plaintiff that he was experiencing “[o]pen lesions
on his legs running blood and fluid.” (Id. at 42). On June 24, 2019, Jottie Tidwell wrote a letter to
the Alabama Department of Corrections indicating that they needed Mr. Smothers “transferred to
the Department of Corrections ASAP” due to “the high medical risks for us at the Walker County
Jail.” (Doc. # 70-13 at 2).
Mr. Smothers was hospitalized at Walker Baptist Hospital on August 2, 2019. (Doc. # 70-
16 at 31, 40). On August 3, 2019, Childers emailed Sheriff Smith about Mr. Smothers’s “cellulitis,”

which Sheriff Smith testified was the first time he had “heard anything about Smothers.” (Doc. #
70-2 at 53, 112). On August 6, 2019, Mr. Smothers was transferred to the Alabama Department of
Corrections at Kilby Prison. (Docs. # 3 ¶ 93; # 70-4 at 53; # 70-15 at 39; # 70-2 at 37). After being
sent to Kilby Prison, Mr. Smothers was deemed “nonresponsive” and was hospitalized at Jackson
Hospital in Montgomery, where he died from septic shock on August 12, 2019. (Docs. # 3 ¶¶ 90-
96; # 70-15 at 1; # 70-4 at 53; # 70-16 at 40, 132, 146).

5 Plaintiff also testified that Mr. Smothers was scheduled to begin shots for his liver issues the morning after
he was arrested. (Doc. # 70-4 at 54). When Mr. Smothers was arrested, Plaintiff told the arresting officers about Mr.
Smothers’s appointment for the liver shots, but she did not offer any medical documentation to confirm this. (Doc. #
70-4 at 55, 58).

6 Mr. Smothers did, however, tell Plaintiff that “one time” his fellow inmates had told jailers that Mr.
Smothers needed attention, and “nobody ever showed up.” (Doc. # 70-4 at 40).
IV. Analysis
Plaintiff brings a single cause of action against Walker County under § 1983, alleging a
failure to fund medical care. (Doc. # 29-31). Section 1983 provides that “[e]very person who,
under color of any statute . . . subjects, or causes to be subjected, any citizen of the United States .
. . to the deprivation of any rights, privileges, or immunities secured by the Constitution and laws,

shall be liable to the party . . . .” 42 U.S.C. § 1983. Here, Plaintiff alleges that Mr. Smothers was
deprived of his right under the Eighth (and Fourteenth) Amendments to be free from cruel and
unusual punishment. (Doc. # 3 ¶ 128).
In a § 1983 action against a county, a plaintiff bears the burden of demonstrating “that the
constitutional violation occurred as a result of a county policy.” Cagle v. Sutherland, 334 F.3d
980, 986 (11th Cir. 2003). In addition, a plaintiff must show that the county had the “requisite
degree of culpability” and that there is a “direct causal link” between the county’s action and the
deprivation. Id. “[P]roof that a municipality’s legislative body or authorized decisionmaker has
intentionally deprived a plaintiff of a federally protected right necessarily establishes that the

municipality acted culpably.” Bd. of the Cnty. Comm’rs of Bryan Cnty. v. Brown, 520 U.S. 397,
405 (1997). Last, and most importantly, Alabama law does not impose on Walker County a duty
to assure that procedures are in place for inmates to receive appropriate medical care. See Williams
v. Limestone Cnty., Ala., 198 Fed App’x 893, 895 n.2 (11th Cir. 2006) (citing Marsh v. Butler
Cnty., 268 F.3d 1014, 1026 n.6 (11th Cir. 2001)). “Rather, Alabama law assigns counties a ‘limited
role in building and funding the jails.’” Id. (quoting Turquitt v. Jefferson Cnty., Ala., 137 F.3d
1285, 1289-91 (11th Cir. 1998)).
A. Result of County Policy
A plaintiff may establish a municipality’s policy in two ways: “(1) an officially
promulgated [] policy or (2) an unofficial custom or practice . . . shown through the repeated acts
of a final policymaker for the [municipality].” Walker v. City of Calhoun, Ga., 901 F.3d 1245,
1255 (11th Cir. 2018) (quoting Grech v. Clayton Cnty., Ga., 335 F.3d 1326, 1329 (11th Cir. 2003)).

Initially, the court notes that the Walker County Sheriff was not a final policymaker for
Walker County. A county does not establish a policy through an official merely because that
official has discretion in the exercise of their functions. Pembaur v. City of Cincinnati, 475 U.S.
469, 481-82 (1986). Further, the Alabama Supreme Court has held that the sheriff’s authority,
which is “over the jail,” is “totally independent” of a county’s authority. King v. Colbert Cnty.,
620 So.2d 623, 625 (Ala. 1993). A county pays the salaries of the sheriff and jail personnel, Ala.
Code §§ 11-12-15(a)(2), 36-22-16, but this “does not translate into control over him,” and “at
most” gives a county an “attenuated and indirect influence over the sheriff’s operations.”
McMillian v. Monroe Cnty., Ala., 520 U.S. 781, 792 (1997). Thus, the Sheriff of the Walker County

Jail did not have the authority to make policy on behalf of Walker County.
Plaintiff argues that Walker County’s policy was to continue to contract with PFHS “to
save money,” and in doing so it acted in “deliberate indifference to Smothers constitutional rights.”
(Doc. # 82 at 18). Plaintiff also argues that this policy was embodied in the CFS with PFHS, which
directed PFHS to “perform wound care services” and “pay for doctor’s visits at the jail” in order
to “further minimize its cost” (Id.). Further, Plaintiff emphasizes, “to the exclusion of the Sheriff
. . . only the County could cancel the contract [with PFHS].” (Doc. # 82 at 18-19). Plaintiff then
points out that although Sheriff Smith made Walker County aware of the fact that PFHS was not
in compliance with its CFS – by only having doctors come to the Walker County Jail once a month
instead of once a week, and by staffing the jail with nurses’ assistants – Walker County did not
solicit bids for a different provider until 2021. (Id. at 19). Finally, Plaintiff alleges that once Sheriff
Smith implemented his policy of sending inmates needing medical attention directly to the
hospital, thus increasing the cost of inmate medical care, Walker County discouraged this policy
by threatening to cut other items in Sheriff Smith’s budget. (Id. at 20).

Defendant argues that Walker County’s policy was embodied in its “contractual
arrangement for inmate medical services” with PFHS, which included paying “$472,506.92 for
inmate medical care.” (Docs. # 77 at 12; # 70-10 at 3). Defendant also highlights that “Walker
County has consistently funded medical care at the jail even during financially challenging periods
such as facing bankruptcy,” and notes that without dispute, Walker County has never refused to
pay a bill for outside medical care for inmates. (Doc. # 77 at 13).
The parties do not dispute that at least part of Walker County’s policy was embodied in the
CFS with PFHS. The contract that was in place in 2019, when Mr. Smothers resided in Walker
County Jail, was the 2016 CFS. This CFS required PFHS to provide “basic and adequate medical

care, treatment(s) and service(s) to the County inmates,” a “properly licensed and credentialed
medical team including a physician, dentist or advanced practice nurse” to come to the jail once a
week, a “physician dentist, or advanced practice nurse on call” 24/7, and “two nurses on site”
seven days a week. (See Doc. # 70-9 at 3) (emphasis added). Although Walker County was made
aware of PFHS’s non-compliance with the CFHS, Sheriff Smith was the actor responsible for
ensuring compliance with the contract. Nevertheless, it was part of Walker County’s policy to
continue to contract with PFHS after being made aware of this non-compliance, as it chose to
continue the CFS on a month-to-month basis during that timeframe.
There is a question as to whether part of Walker County’s policy was to save money in
deliberate indifference to providing adequate inmate medical care. There is no evidence that
Walker County’s explicit policy was to save money at the cost of adequate inmate medical care.
True, PFHS was one of the lowest bids for providing inmate health care, and the County’s threat
of bankruptcy in 2017 would undoubtedly have raised the issue of cost savings to the County.

(Doc. # 70-1 at 30). But the County’s choice of a low-cost provider in the light of looming
bankruptcy at most establishes that cost was a major factor in their choice of medical care
providers. Defendant has presented undisputed evidence that the CFS entered into with PFHS
required a certain minimal amount of medical care for inmates.
Further, beyond pointing to the fact that PFHS was one of the lowest cost bidders to provide
medical care, Plaintiff has not presented any Rule 56 evidence to show that Walker County’s policy
was to prioritize cost savings over selecting an adequate inmate medical care provider. Evidence
of PFHS’s focus on cost savings includes a provision in the 2019 CFS that directed PFHS to handle
certain services, such as wound dressing or ordering medications, in house. (Doc. # 70-5 at 4).

Additionally, in 2015, Childers sent an email to Walker County touting his cost savings – such as
cutting pharmaceutical costs, transferring fewer inmates out of jail for medical care, conducting
dental care in house, and converting medical records to an electronic format. (Doc. # 70-7 at 2-3).
At the same time, though, once Sheriff Smith began his policy of sending inmates to the hospital
if they needed medical attention, Walker County did not make any cuts to his budget, nor did they
direct him to end the policy – although the county did inquire why medical costs had increased.
(Doc. # 70-2 at 48, 59). That Walker County noticed and inquired about rising costs is unsurprising.
But, Walker County never refused to pay any outside medical bill. (Id. at 59). Further, even though
Walker County was facing bankruptcy in 2017, they did not make significant cuts to the Sheriff’s
budget, which is the source of funding for inmate medical care. In fact, over time, Walker County
has increased the proportion of their general fund budget from 45% in 2008-2009 to 60% in 2018-
2019. (Doc. # 70-10 at 2). In sum, Plaintiff’s claim that Walker County’s policy to contract with
PFHS was “to save money” with “deliberate indifference to Smothers constitutional rights” simply
is not supported by the summary judgment record. (Doc. # 82 at 18).

Therefore, Plaintiff has not successfully rebutted Walker County’s record evidence that at
the time of Mr. Smothers’s death, Walker County’s policy was merely to continue to contract with
PFHS through its 2019 CFS.
B. Requisite Degree of Culpability
“[P]roof that a municipality’s legislative body or authorized decisionmaker has
intentionally deprived a plaintiff of a federally protected right necessarily establishes that the
municipality acted culpably.” Bd. of Cnty. Comm’rs of Bryan Cnty., Okl. v. Brown, 520 U.S. 397,
405 (1997). “A plaintiff must show that the municipal action was taken with the requisite degree
of culpability, i.e., that the municipal action was taken with deliberate indifference to its known or

obvious consequences.” Davis v. DeKalb Cnty. School Dist., 233 F.3d 1367, 1375-76 (11th Cir.
2000).
Defendant Walker County argues that Plaintiff’s failure to fund claim is a veiled-
respondeat-superior claim that seeks to hold Walker County liable for the failings of Childers and
PFHS. (Doc. # 7 at 2). Municipalities and other local government units cannot be held liable under
§ 1983 on a theory of respondeat superior. Monell v. Dept. of Soc. Servs. of City of New York, 436
U.S. 658, 691 (1978). So, any allegations in this case that are directed at Walker County and not
relevant to a failure to fund claim are wide of the target.
Plaintiff’s Response to Walker County’s Motion for Summary Judgment argues that under
the Eleventh Circuit case Ancata v. Prison Health Services, Inc., Walker County had a non-
delegable duty to provide necessary and adequate medical care and that Walker County remained
liable for any unconstitutional deprivations caused by the policies and customs of a medical
provider. (Doc. # 82 at 10-11) (citing Ancata v. Prison Health Servs., Inc., 769 F.2d 700, 705 (11th

Cir. 1985)). Defendant Walker County’s Reply to Plaintiff’s Response argues that Ancata is
inapposite because it applied Florida law, which is substantively different than Alabama law.
Florida law, Walker County contends, imposes a distinct duty on Florida counties to actually
provide medical care, not just to fund it. (Doc. # 83 at 2). The court agrees with Walker County.
Alabama law applies a different standard to Alabama counties than Florida law applies to
Florida counties. See Kister v. Quality Correctional Health Care, 2018 WL 4794478, at *2 (N.D.
Ala. Oct. 3, 2018) (acknowledging that the Florida statute in Ancata is materially different from
its Alabama corollary). A local government is liable under Section 1983 “only for acts for which
the local government is actually responsible.” Marsh v. Butler Cnty., Ala., 268 F.3d 1014, 1027

(11th Cir. 2001). As the Eleventh Circuit has held, “Alabama counties have no duties with respect
to the daily operation of the county jails and no authority to dictate how the jails are run.” Turquitt
v. Jefferson Cnty., 137 F.3d 1285, 1291 (11th Cir. 1998). Rather, “[t]he duties of the counties with
respect to the jails are limited to funding the operation of the jail and to providing facilities to
house the jail.” Id. at 1289.
As provided by the Code of Alabama, Alabama counties are responsible for funding
“[n]ecessary medicine and medical attention to those prisoners who are sick or injured . . . .” Ala.
Code 1975 § 14-6-19. This statute places a duty on Alabama counties that is limited to funding
medical care for inmates. See Shaw v. Coosa Cnty. Comm’n, 330 F. Supp. 2d 1285, 1289 (M.D.
Ala. 2004) (citing Gaines v. Choctaw Cnty. Comm’n, 242 F. Supp. 2d 1153, 1161 (S.D. Ala.
2003)); Cole v. Walker Cnty., 2015 WL 1733810 at *4. Under Alabama law, a county “is not
responsible for assuring procedures are in place for inmates to receive medical care.” Williams v.
Limestone Cnty., Ala., 198 Fed. App’x 893, 895 n.2 (11th Cir. 2006).7
Walker County argues that because its contract with PFHS required PFHS to provide “basic

and adequate” medical care, the CFS is proof that the County provided medical care and did not
violate Mr. Smothers’s constitutional rights. (Doc. # 77 at 2). Specifically, Walker County points
to the contract requirement that PFHS provide “basic and adequate” medical care for inmates seven
days a week, and that PFHS provide “a properly licensed and credentialed medical team including
a physician, dentist, or [an] advanced practice nurse to come to the jail for formal clinic one day a
week or more as indicated according to acuity.” (Id.). Further, Walker County argues that this
contract “required that a medical professional be on call seven days a week and twenty-four hours
per day.” (Id.). Walker County further asserts that “[t]he County expected that [PFHS] would meet
the terms of contract.” (Id.). Finally, Walker County contends that the County met its duty to fund

medical care because it allocated 60% of its budget to the Sheriff’s Office, and of that 60%, 8%
(or $472,506.92) was spent on medical care for inmates. (Id.).
Plaintiff counters that Sheriff Smith put Walker County on notice that PFHS was not
complying with the terms of the 2019 CFS and that “[d]espite the non-compliant condition, the
County looked the other way and, in an effort to mitigate cost, renewed the contract with PFHS.”
(Doc. # 82 at 19). Plaintiff claims that because of Walker County’s notice of PFHS’s non-

7 Although Alabama Code § 11-14-10 establishes the duty of counties to “maintain a jail,” the Alabama
Supreme Court clarified that this phrase was “intended to require the county commission to keep a jail and all
equipment therein in a state of repair and to preserve it from failure or decline.” Keeton v. Fayette Cnty., 558 So.2d
884, 886 (Ala. 1989). The Eleventh Circuit reiterated that the duty in § 11-14-10 to “maintain a jail” “pertains
exclusively to the physical plant of the jail.” Turquitt, 137 F.3d at 1290.
compliance as well as of prior inmate deaths under PFHS care, the County’s choice “not to solicit
bids or change providers” until two years later constituted a breach of the County’s duty to fund
inmate medical care. (Id. at 19-20). But this argument fails because, again, Walker County has no
duty to provide medical care in the jail. Its duty is to fund that care.
First, there is no dispute that Walker County paid the contract price to PFHS to provide

medical care as provided under the CFS. Plaintiff’s Response to Walker County’s Motion for
Summary Judgment admits that, according to Sheriff Smith, Walker County never refused to pay
a bill for outside medical care for inmates. (Docs. # 70-2 at 59; # 77 at 6; # 82 at 4). Plaintiff also
does not dispute that Walker County fully paid PFHS for their provision of inmate medical care.
And, as discussed above, there is no genuine dispute that Walker County’s explicit policy was
memorialized in the CFS with PFHS, and that Walker County did not have a policy of prioritizing
money saving over providing necessary inmate medical care.
Second, the thrust of Plaintiff’s argument appears to center on three points:
1. A reasonable juror could find that as of 2019, Walker County was put on notice that

PFHS was not complying with certain terms of its CFS. Sheriff Smith told County Commissioner
Chairman Jerry Bishop that he was concerned with the low quality of medical care being provided
by Childers and PFHS, and specifically the concern that Childers was not following the CFS. (Doc.
# 70-2 at 47-49). Sheriff Smith also testified that he generally put Walker County on notice that
PFHS was only providing CNAs (nurse assistants) rather than the “two nurses on site” required by
the CFS. (See Docs. # 70-1 at 27, 34; # 70-2 at 47-49). Additionally, in a 2016 email to Walker
County, Childers wrote that a doctor came to the jail monthly even though the CFS at the time
required a “medical team” to “come to the jail for formal clinic one (1) day per week.” (Docs. #
70-6 at 3; # 70-8 at 2) (emphasis added).
2. A reasonable juror could also find that, as of 2019, Walker County was on notice
that there were allegations that PFHS provided low quality medical care. One of the issues Sheriff
Smith ran on in his 2018 campaign was the low quality of medical care at the Walker County Jail.
(Doc. # 70-2 at 46). Further, Walker County Administrator Robbie Dickerson testified that she had
become aware that after PFHS’s contract began, several inmates had died and that there were

complaints that these deaths were due to a lack of medical care. (Doc. # 70-1 at 27).
3. Finally, a reasonable juror could find that as of 2019, Walker County had chosen
not to solicit new bids or cancel the month-to-month contract that it had with PFHS. Additionally,
Sheriff Smith testified that Mr. Bishop indicated that because “it was his election cycle . . . we
would address the contract and the bid after the election.” (Doc. # 70-2 at 57).
These facts indicate that Walker County chose not to solicit new bids for the provision of
inmate medical care despite being on notice of PFHS’s non-compliance with the CFS and
allegations that PFHS provided low quality medical care. But, this is not enough to show that
Walker County had the requisite degree of culpability under Alabama law. Alabama law imposes

on Walker County only the duty to fund “[n]ecessary medicine and medical attention to those
prisoners who are sick or injured . . . .” Ala. Code 1975 § 14-6-19. The cases have interpreted this
as limiting counties to the duty to fund medical care for inmates. See Shaw v. Coosa Cnty. Comm’n,
330 F. Supp. 2d 1285, 1289 (M.D. Ala. 2004) (citing Gaines v. Choctaw Cnty. Comm’n, 242 F.
Supp. 2d 1153, 1161 (S.D. Ala. 2003)); Cole v. Walker Cnty., 2015 WL 1733810 at *4. Under
Alabama law, a county “is not responsible for assuring procedures are in place for inmates to
receive medical care.” Williams v. Limestone Cnty., Ala., 198 Fed. App’x 893, 895 n.2 (11th Cir.
2006). This limits Walker County’s duty as one to pay for necessary medical care. It is undisputed
that Walker County fulfilled this duty.
Walker County paid PFHS its full contract price to provide “basic and adequate medical
care.” (Doc. # 70-9 at 3). Walker County never refused to pay for outside medical care when
Sheriff Smith began his policy of sending inmates to outside hospitals whenever they were hurt.
(Doc. # 70-2 at 59). Finally, the numbers indicate that despite impending bankruptcy in 2017,
Walker County did not materially cut the budget for Sheriff Smith or, by extension, for inmate

medical care. While Sheriff Smith’s budget in 2016-2017 was $5,806,457.56, in 2017-2018 it was
only reduced to $5,036,986.78 and in 2018-2019 it was back up to $5,935,889.64. (Doc. # 70-10
at 3). And, in any event, as Mr. Smothers was in the Walker County Jail in 2019, there is no
indication that Walker County’s possible bankruptcy and budget cuts in other areas in 2017
affected the funding of Mr. Smothers’s necessary medical care. In addition, although Walker
County could have elected to solicit new bids after being put on notice of PFHS’s non-compliance
with the CFS and their allegedly low quality of inmate medical care, Plaintiff presented no case
law (and the court is unaware of any) to support the conclusion that an Alabama county has a duty
to change medical providers once being put on notice of their alleged low quality or non-

compliance with portions of a contract. In this § 1983 failure to fund claim, the law asks only one
question in relation to a municipality in this context: did it fund “[n]ecessary medicine and medical
attention to those prisoners who are sick or injured”? Ala. Code 1975 § 14-6-19. Walker County
did so by paying PFHS to provide “adequate” services to inmates and by paying all bills for outside
medical care. Any claim that the County is liable for the subpar medical services of the medical
provider hired to treat patients is essentially a claim for respondeat-superior liability, which is not
a viable theory under § 1983.
V. Conclusion
For the reasons discussed above, Walker County’s Motion for Summary Judgment (Doc.
# 69) is due to be granted. An order consistent with this memorandum opinion will be entered
contemporaneously.
DONE and ORDERED this September 17, 2024.

□□ DAVID Zz. 24 2
CHIEF U.S. DISTRICT JUDGE

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Source: Frix Law Library, https://www.frixlaw.com/law-library/cases/10631244. Public record. Not legal advice.